HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPVLD FOR APPLICATION TO BE ACCEPTED
Date: r),I\- Permit Number:
C REC - WED
Building Permit Application 14 AY V, 9 2-0 17
Planning and Development Services PERMIT71ING
Building and Code Regulation Division St. Lucie
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.-PROPOSED IMPROVEMENT LOCATION: ._'
Address: 5-2
Legal Description:
Property Tax ID#: 0 )0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION 0FVbRK: .1
W
.5e.-e_ ;4-
r1o, � 1_J/
CONSTRUCTION ON CTION INFORMATION.
Add itiona wor to eperFo-r-me under this permit-check all that apply:l k -a
—HVAC Gas Tank —Gas Piping Shutters Windows/Doors
—Electric ✓Plumbing —Sprinklers Generator Roof � Roof pitch
. —Total Sq. Ft of Construction: 41-
9 Sq. Ft. of First Floor:
e iD
Cost of Construction: $ 7 OZ) Utilities: —Sewer —Septic Building He'ight:
CONTRAtTO'
0. NER/L.ESSE' R:
Name Name:
Address: b 'Y iz'� Company:
City: J'e-,"se-o �—c-A State: Address:
Zip Code: 7 z(9 5-7— Fax: City: State:
Phone No. 6 03 7 �O 5YL0 Zip Code: Fax:
E-M a i 1: "Y,. !P"r pro f,Co;-L- Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
valueIf of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENIAWANFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: OvJ vl Name:
Address: Address: lope) Ni
City: J State: City: -ems 5 7r,t k State: L
Zip: Phone: Zip: :3;Y 9 S 7 Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspe tion. If you intend to obtain financing, consult with lender or an attorney before
commencing recording our Notice of Commencement.
Signatur- of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA`` STATE OF FLORIDA
COUNTY OF y�. 1�7C1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this O�—day of 20 L'-Lby this day of 20 by
(Name of pe son ac now edging) (Name of person acknowledging)
?('�K b A A `�' �� -)
'
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification v/ Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
KAREN S. NIELSE
YP
lull
i
x r' I 1 503
=N *' My Commission Expires
Revised 07/15/2014
�'�,; ;;;� June 12, 2018
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DATE
COMPLETE
INITIALS