HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �—� . Permit Number:
%im
RECEIVED
Building Permit.Application MAR 15 1p71
Planning and Development Services artment
Building and Code Regulation Division perrn�tt�uctr�ountY
St•
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT TYPE:
Address: (gZ)q ()Uf1e Dr-7P, 4V•
Property Tax ID#: }�0 • 5 3 I • 0062,, aaD ° 9 Lot No.
Site Plan Name: Block No.
Project Name:
t1
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Additional work to be performed under this permit—check all 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:$ / Utilities: —Sewer Septic Building Height:
Im MOT
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111 MA
Name ��I cVL i s L n Name. -b`1' T- 7'rZ
Address: aq 0ze,4 de Uiv Company: LCI min - GV6 j T-& j j . 0
City: 6AGt State: L Address: /?Qj b 5LJ og;"oro
Zip Code: 3 0 K Fax: City:
Phone No. rc Jb .y���,cj�tj/ Zip Code3+99'6 Fax:
E-Mail: S4a 7,� e,YA%d-oo , (5-o Phone No I I Z 0j ' `L _t)I
Fill in fee simple Title Holder on next page(if different E-Mail �% �� o�J yd a f
from the Owner listed above) State or County License GAG)9)>,_5,
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 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 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,suyimming 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/LessWdoniractor as Agent for Owner Sign ure o Contractor/Licens Hol
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STATE-OF FLORIDA STATE OF FLORIDA
COUNTY OF 't-pLI_. t.�)c',l COUNTY OF_ t Or,( ,
The for oing instrument was cknowledged before me The fogoing instru t was cknowledged before me
this�day of 20�-1 by this day of 20_')_1 by
on
Name of person making statement. / Name of person making statement.
Personally Known OR Produced Identification I� Personally Known OR Produced Identification
Type of Identifica ' Type of Identificatiq�;
Produced__- Produced_
Q._2.2�u1r yJ
(Signature of N ELSEN (Signature of Nota Public-Sat o F r'
KARF_N S.
KAREN S. NI�SEN
Commission No. ���`" Bn state 0� Florid/ Notta2 Public uuu, oh���
lli}FSJ Commission �pS�YP�B�•,
;3sion a lorida-N � ublic
=� My Commission Expires _
=; _. Commission # GG 207484
itine 12. 2022 ';; arMy Commission Expires
June 12, 2022
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