HomeMy WebLinkAboutBuilding Permit Application-UPDATED All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: tb i z• 2.07 7 Permit Number:
Building Permit Application ;I
Planning and Development Services '
Building and code Regulation Division Commercial Residential X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR: Tillberg William/Dana
PROPOSED !M"PR01/EME:NTLOCATl.ON
Address: 1313 Lone Pine Drive Ft. Pierce, FI 349
2 0
3409-505-0026-00 -
Property Tax ID##: Lot No.21 ,f
--i-Site Plan Name:. Block No. 51-21
- Project Name:
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4TAIG€D;.DESCRIPTIONtO>=.WORK:
installation ofpool enclosure
. .i
New Electrical Meter Second Electrical Meter
CONSTRUGTfO.N;LNFOf:M:ATION: :: .;_
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gays Piping Shutters _Windows/Doors Pond'
_Electric Plumbing Sprinklers Generator _Roof Pitch.j
Total Sq.Ft of Construction: 1260 sq feet Sq.Ft.of First Floor: !
Cost of Construction:$ 12,000.00 Utilities: —Sewer _Septic Building Height: i
_ I
01NNER LESSEE: `CO CTOR:, -;
5
NameBill Tillberg_ r
Nam-'
Address:1313 Lone`Pine Drive Company:* �
City: Fort Pierce State:— AddrE
N J- treet
Ci P_L State•FL
Zip Code- 34982 Fax:
_
Phone No.561 262 2048 Zip Code: 3' Fax: �.
E-Mail: Phone No!~� !
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Fill in fee simple Title Holder on next page(if different E-Mailstone aluminum@yahoo.comn
from the Owner listed above) State or unty License 13974
If value of construction is 2506 or more,a RECORDED Notice of Commencement is required. II
if value of HAVC is$7500 or more,a RECORDED Notice of Commencement is required.
to-0-5
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 YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A,NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE MRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOU DER OR AWATTORNEY BEFORE RECORDING YQUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of::A 2 by this day of 20_ by
is► � �
Name of iYerson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced L Produced
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(Signature of Notary Pu ic-State of c}2\ Js F I_L FN G Notary Public-State of Florida )
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
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