HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEi..'>MD
Date: • a-� • a b� Permit Nu ber: ° O U ^�ri Y `
� �"O
�'Cap�r�
aRECEIVED
i R
Building Permit Application MAY 2 6.1011
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
dclress—17�1��% lL mii i --for
pro FNir-ty Tax -ID-#.
Site Plan Name:
Project Name:
0
u e na
r
Additional work to be performed under this permit— check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters
_ Electric Plumbing _ Sprinklers
Total SqE:7E oilYstruction•
Lot No.
Block No.
Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction:? $ ��®� Utilities
Sewer _ Septic Building Height:
w--
..:.x:., y. r•. :Y:: 4/i Ra 'a.`"k'3v Y�'t' act-'.'' i�.-',,, T¢y`At"✓fl`'. ±t F yM '...'
2 2 Syj�i[{
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Name �// rQ ie�f
ame. fJQV) ' 1—s� t r
(4 ompany: 52 _1 S
Address:?
y�(Company:
Address: f(J� t LOT'
�' Ct; State:
City: G'L" _
2 `4J.� . Fax:
Zip Code: 34�
tit IiGI�. State:
i y
Phone No. %7
Zip Code: lr e Fax:
Phone 77�-3v
E-Mail:
o .
E-Mail r� C S s/- a
Fill in.fee simple Title Holder on next page ( if different
r
from the Owner listed above)
State or County License
If value of construction is $z5uu or more, a Kt:LUKUtU Notice or t UrnmeJiLamcnL la —4-9—
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
/05
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City.
Zip: Phone:_
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City -
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
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
me Owners Association rules, -bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable Ho
structure. Please consult with your Home Owners As 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 Amendmerifs.
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, JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDiNi",.YOUR NOTICE OF COMMENCEMENT.",
of Owner
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged efore me
this may of 20a�by
Name of person making statement.
Personally Known
Type of Identifiral
Produced •yi
(Signature
Commission N
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
OR Produced Identification
c- State of Florida
KAREN S.4ILSEN
State_ef Florid A@ ry Publi
Comr rnm ssion_E p1res
June 12, 20
COUNTER I REVIEW
REVIEW
g a ure'of Contractor/License Holder
STATE OF FLORID 1
COUNTY OF
The for oing instru ent was acknowledg ��}}efore me
thisday of 20Iby
�v1�r� �IACIS�O
Name of person making statement.
Personally Known - OR Produced Identification
Type of ldentiUTTion
Produced _ / n
KAR NIELSEN
,te of Florida -Notary Pug
ommssio�GG 20745
My Commission Expires
00
R I REVIEW REVIEW N SEAATUR�TLE MANGR
REV REVIEW
REVIEW