HomeMy WebLinkAboutBuilding Permit Application AIJ APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1� 031
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-2553 Fax: (772)4624578 Commercial Residential
PERMIT APPLICATION FOR:
Address: ?,{ b L4 11 16 ` U
Legal Description:
Property Tax ID#: 1 13' Diz• l`�i Lot No.
Site Plan Name: Block No.
.Project Name:
Setbacks f=ront Back: Rig Side: Left Side:
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it►ona war to a pe orme un er t is permit—c ec a tat app y:
,Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors
Electric Plumbing Sprinklers „Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
MR
OWN- W Non
Name f" kke 01A Ug Name:
Address t d� 1 Company: R, 1
City: Sta qeV Address:
Zip Cod N Q'S I Fax: City: State;
Phone No, '�\n Zip Cad P Fax:
E-Mail: Phone No `r7 �?
Fill in fee simple Title Holder on next page(if different E-Mail _ G
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
0` .-S) �-T U Y' \1 1
_=Mv
DESIGNER ENGINEER: of Ap Ccabl MORTGAGE COMPANY: _Not Applicable
Name: �'- ame:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable.Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Les, tractor as Agp1t or Owner Signature of Contractor/License Holder
STATE OF FLORI09 A STATE OF FLORIDAe,.L �
COUNTY OF �,, Q� ,, COUNTY OF
i
Th�e�f going ins m t as acknowle before me The or ing inst e w acknowledge efore me
thisl� day of� ,2c� by this day of��� 20_/ by
(Name of person acknowledging) (Name of person acknowledging)
VWA Q1QA1AV(M09&0,
(Signature ofVotary(Public-!;t6tila of Flai a) (Signature ofAotary Public-S to of Q6 }
Personally Knowny OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identi CA
Produced Produced
`,,oSYra�••. KARtEYMARiEGiE5Y•VARNEY
KARLEY MARIE GIESY-VARNEY 0ssion#bri'�rFlarlda
:° °`� Nota Public-State of �- CommfsslansGG099 1
Commission . 7 �`'} Commission M Camm.ExplresMay1631)
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My comm.Expires May 1,2421 9��"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
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