HomeMy WebLinkAboutBuilding Permit Application All APPLISAB6 INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
+' 11 RE:ED
Building Permit Applicatio FEg2019Planning and Development ServicesBuilding and Code Regulation Division ST. Lucie ,Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
V .
SD1lE00' OCAT
nn
Address: ��Q� //�7S l"lis /fC
Legal Description:
Property Tax ID#:�� ) ( ' fJ' a 210 ' `q Lot No.
Site Plan Name: Block No.
Project Name:
setbacks Front Back: Right Side: Left Side:
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Additional work to be pertorme un er this permit-check k a that apply:
_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:$ oMTI," Utilities: —Sewer- —Septic Building Height:
ER/LE-�5 x CNTRAC + R.
Name �fd / Myz>z Nam;e ;
Address: 7��//�/_5d" (� Company.
City:�, — EL2_�6 State:r/ Address:
Zip Code: Fax: City: State:
Phone No. n/4;.V• 07 3 /7� Zip Code: Fax:
E-Mail: /1�11�1�1.1L �(�/�2 ffl(gh"/Ln��G�'1/ Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
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/ — PP MORTGAGE COMPANY: • _"Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
'FEESIMPLE 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 thepermit 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/Lessee/ ontractoras Agent for Owner Signature of,Contractor/License Holder
STATE OF FLORIP STATE OF FLORIDA
COUNTY OF- COUNTY OF
The forgoing instru nT'as acknowledgeqbefore me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
P� � �
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificatiAn. Type of Identification
Produced ji Produced
(Sign ture of Notary Publi Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
4Y PV��i
Commission No 3r° � Sta lorida-Notary Public
Commission# GG 207484 ommission No. (Seal) '
=7 P'
f My Commission Expires
o ���.��
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17