HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `
RECEIVED
Permit Applicati n
Planning and Developer entServices �AN 0 $ 2019
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772)462-1553 Fax: (772)462=1578 Commercial Resid 'a
PERMIT APPLICATION FOR:
f 110
Address: 1/001 A✓G X �' Z,'ertt Fl 3 /
Legal Description:
Property Tax ID#:44 1110, ` 703 O 0,'j2 –000 6 Lot No.
Site Plan Name: �A - Block No.
Project Name: h GNC Z
Setbacks Front Back: )< Right Side: Left Side: /
A )gla
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Additional work to be pertormed under this permit–check all that appy:
_Mechanical _GasTank _Gas Piping Xhutters —Windows/..Doors "
Electric —Plumbing -Sprinklers" —Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 9 y Utilities: —Sewer _Septic Building Height: ;2 0
Name:' Lr4-*a' &Z Name:77
Address: i'i; Awe Company: 1%1b'64wA _eiq!Lz
City: State: Address:_x.1_ 1' Le- 4(&
Zip.Code:�'3 t/S f/4 Fax: City: �'r• �;love State: ���l rr��
Phone No.79 – „�0.7– 6 fll f Zip Code: 3 q9y i Fax:_27Z-KJ 6tY f
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:--�ai'✓1,.��,� J ! (9 4-Al" .410
from the Owner listed above) State or County License: .
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: ..
FEE SIMPLE TITLEHOLDER: 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 iri'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.your our Notice of Commencement.
1
ignature of Owner/Agent/Lessee gnature of Con or/L'icense Holder
STATE OF FLORIDAI STATE OF FLORID • !
COUNTY OF ULIL COUNTY OF `
The f ping instr ment was acknowledge before me The fo going instr ment was acknowledged before.me
this day of 20 by this day of 20 by:.
ICZ
(Name of person ac nowledging) (Name of person acknowledging)
r
i
(7nature of Notary Public-State o Flbrida) (Signature of Notary Public-State of Florida)
Personally Known OR Produce .Identification ". � Personally Known OR Produced Identification
Type of Identification.Produced f, %f9pe of Identification Produce
KAREN S'NIELSEN ,sm 1plo, KAREN.
°�tYp°''� �` ommission No. =°` �A`�- p�fFlorida=Notary PS. u
Commission NO. �"P ��,Sta' lorida-N'otary Publi _�.c�p 4nission #GG 2074
Commission.#GG 207484 V!►'PP� .:My Commission Expire
My Comr*,ission Expires °%,F, °.� June 12., 2022
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