HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number-: Rol I /_\IJ
II RECEIVED
Building Permit ApplicatE
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Planning-and Development Services
Building and Code Regulation Division cie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: Cy-
Address:
Legal Description: c+✓dejJ -D 3 9 510 7A.. i/ or ) + 2 2 1—Yd
Property Tax ID#: V 0-3-- 000-2 Lot No. U-�O
,Site-Plan Name:_ .0111A Block No.J-IE2.
Project Name:
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Setbacks Front Back: l Right Side: Left Side:
Room'a,
r _ "l -m-liewww-1
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Itional work to be performed under t is permit—check all t at app y:
_Mechanical _Gas Tank _Gas Piping Shutters . . _ Windows/Doors ,
Electric _Plumbing' —.Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$�� ,?b Utilities: _Sewer _Septic Builtling Height:
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Name h Ze n r 3o Name:
Address: 1 0 &'--b ✓ _ Company: CJ Au' / ✓' r
City: . ,.. e ae. •�
Zip-Code: Fax: �il7 City: Anew-Ct Stater/
Phone No.77.2= Zip Code:(,?Y9yi Fax:72—A- Y6/—dfuff_
E-Mail: Phone No. 722-646/^ f/
Fill in fee simp a Title Holder on next page(if different E-Mail:_r-_0107. jr jG A Y414,Ao. C v 0--7
from the Owner.listed above) State or County License: IfCC 13044_ Oay
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _-kNot Applicable
Name: Name:
Address: Address:
City: State: City: State,
Zip: 'Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: __JNot 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 Associatibh 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 hi*your paying twice for
improvements to your property.A Notice of Commencement must be record ed.and 0sted 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 rgenatur4eofZCpn��eor/Llcense Holder
STATE OF FLORIDAI STATE OF FLORID • •!
COUNTY OF COUNTY OF `
The forgoing instr ent was acknowledge before me The fo going instr ment was acknowledged before me
this day of`� ,20by this T day of 20-Li by.
'AA VIA4C.
(Name of person ac cnowledging) (Name of person acknowledging)
i
( • nature of Notary Public-State o .FI'orid.a (Signature of Notary Public-State of Florida
Personally Known OR Produce .Identification wY/ Personally Known OR Produced Identification
Type of Identification.Produced ype of Identification Produce
KAREN S"NIELSEN ,����;;,�,,, KAREN. N
�� r"n'ab" +. b` �- f r-iorida=Notary Pu
Commission No. °�i;.� fjfllorida Notary Publi ommission No. �_ °'gg
8ta .c1'�issian #GG 2074
_: •� .C6mrnis.sio9.#GG 207484 � �^'. -M Commission Expire
=?, My Comrnission Expires 'o;;o����� y_ June 12, 2022
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COUNTER REVIEW .; REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014