HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETeu'rOR APPLICATION TO,;BE ACCEPTED ►' j "j
Date: % 2-7 7 Permit Number:
Building Permit Application JUL 2120P
Planning and Development Services
Buildingand Code Regulation Division PtP,f�tl'ounty
9 St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
C f 11
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Legal Description;- Li I 11Z/C ' 7-T_ / '-G C_�M
to -C L tr N T k/
Property Tax ID #: JZ10 Z - 1 D rW- 041''3" 00 -0 Site Plan Name:
Project Name:
Setbacks. Front Back:. Right Side: Left Side:
_Mechanical _ Gas Tank — Gas Piping
_ Electric i,"'Plumbing rinklers
Total Sq. Ft of Construction:
✓f�o
. ,_J .
Cost of Construction: $
I
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
/windows/Doors
✓Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
Address:J`� U �Lf
City: State: la
Zip Code:_ FZ Fax:
Phone No. i�7/ S-7 -Z
1_
E-Mail4-be-1 4 �4-q i ) JCL-C-4M -
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Fill in fee simple'Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
I
If value of construction is 2S00 or more, a RECORDED Notice of Commencement is required.
IGNER/ENGINEER:
ll
Not Applicable MORTGAGE COMPANY: — Not Applicable
e:
Name:
ress:
Address:
City:
Stater 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) do hereby agree that Twill, 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signs ure q106WI Les e/ ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDAJ
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr meet was acknowledged before me
The forgoing instrument was acknowledged before me'
this day of 2011 by .
this day of . , 20_ by
,A.
(Name of pers n acknowledging)
(Name of person acknowledging)
(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
Type of Identification .
Produced IEL
Produced
. KAREN S. NIEI
Commission No., f ,;a�' I)
Commission
dtlnm sion No. (Seal)
34 *_ It FF
- My Commission it
i�;yJf
115637
Aires'
U ,UPON`,,
REVIEWS
FRONT
PLANS
VEGETATION
SEA TURTLE
MANGROVE
ZONING
SUPERVISOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
l
RECEIVED
DATE
COMPLETED
ev.