HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BC, --1;IIPLETED FOR APPLICATION TO BE ACCEP' ,
a I
Permit Number:
Date: �• I
RECEIVED
Building Permit Application MAY 12 7011
Planning and Development Services F•2rmitting Department
St. Lucie Count%/
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
5
Site Plan Name:
71,21 oa.IClar,J
C-
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank Gas Piping —Shutters
_ Electric — Plumbing _ Sprinklers _, Generator
Total_Sq. Ft of Construction: Sq. Ft. of First Floor: —
Utilities: Sewer _Septic
�C�e�stof�Construction`:^�$ Q� � D —
me
dress:
Statev-
"� n
Z,ip Code: ZLI Fax:
Phone No. .i �/� Z 7ki
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EWaiI: '-5 Q (mQ () N(0,`
Fi,.I in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Qompany:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County License
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.
S/
Lot No.
Block No.
Windows/Doors
:Roof Pitch
Building Height:
Fax:
State:
:Ei
DESIGNER/ENGINEER: _ Not plicable
Name: C P) A- ti►t'\6r\
Address: Z o
City: r?
Zip: Phone
FEE SIMPLE TITLE HOLDE
Name:
Address:
City:
Zip: Phone:
— Not Applicable
MORTGAGE PANY: .
Name: 2 C
ID
Address:.
City: e-i� t
7i -Z<C) 5 Phon : k
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
made to obtain a permit to do the work and installation as indicated.
OWNER/ CONTRACTOR AFFIDVIT: App ication is hereby
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
structure. Pleasecc consult w with your Hlome Owners Association Association
drreview your deed or any restrictions d covenants that which may apply.
restrict or such
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO 'ENDER OR AN ATTOgNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat fern o Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for oing instr nt was acknowledged Before me
this day of 20� by
1Qamle of person making statement.
Personally Known OR Produced Identification
Type of Identipcation L
Produced �r
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
Name of person making statement.
Personally Known _
Type of Identification
Produced
OR Produced Identification
(Sign to of Notary u (gns, PatN) S. NIELSEN (Signature of Notary Public- State of Florida )
tate of Florida -Notary Public
_. *� Commp# GG 207484 Commission No. (Seal)
Commission No. - _ b
My C mmission Expires
;° F June 12, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER I REVIEW REVIEW REVIEW I REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.