HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED mrn `
Date: \' �J� 'Z� Permit Numbe : )�J y Q
to Iff:
- Building Permit Application
Planning and Development Services
Building and Code.l7egulotion Division Commercial Residential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462:-1553 Fax: (772)462-1578
PERMIT APPLICATION FOR: Uri
D
Address: 667 `�Ieiir.D
Property Tax ID#: `. . Lot No.
Site Plan Name: 1 Block No.
Project Name:
A-I
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L 1
New Electrical Meter Second Electrical Meter
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Ad
VMechanical
I work to be performed under this permit—check all that apply:
—Gas Tank —Gas Piping. —Shutters _Windows/Doors _Pond
_Electric _Plumbing —Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ `7 006-- Utilities: Sewer Septic Building Height:
LEA Ct3y1� � R:
Name L _ Name: c----� v r/
Address: �" `"GIJ.Cs ��/ Company: ' G ci Gda i�
City: State: Address:
Zip Code: 'Fax: City: r—,!� f 44G�'le State:(
Phone No.772-!,�*l 3Y77 Zip Code: Fax:
E-Mail: 6L/c- ;�djo0 q f(&V,,�t . C�� Phone No � 197 S' '?
Fill in fee simple Title Holder on next page(if different E-Mail ov 1
i
from the Owner listed above) State r County License I 8(93 3 17If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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9MMY
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and poste on the jobsite before the first inspection. If you in'end to obtain financing, consult
with lender or a attgrAy before commencing work or recordi ur ice o ommencement.
/'41/'� . "17:'T'
Signature of Owner Le ee/Contractor as Agent for Owner Signature of Contractor cens
STATE OF FLORIDA STATE OF FLORIDA � 11 ''
COUNTYOF 4� L (JaIE_. COUNTYOF �J �
Sworn to (or affirmed)and subscribed before me of Sworn.to (or affirmed)and subscribed before me of
Physical Presence or Online Notarization Physical Presence cir Online Notarization
this2) day o 20j:,C) by thi day of 20_M by
Name of person mal�statement. Name of person makiiAg statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Ident i-ation
Produced 1. Produced
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AP Ah
(Sign@ ur (Signat e`(�R`YPJ AREN S. NIELSEN
KAREN S. NIELSEN _° B�;State of Florida-Notar Pup�i
`��tppY FUBi _ y $��
Commiss _ o'cState of Florida-Notary( ebl)c Commi i Commisgi� 41 GG 2074
*= ommiss,on # GG 207484 %:?oFF�°�: My Commission Expires
My Commission Expires "" �\ June 12 2
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