HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' f 1 Permit Number: 0�� �15 / lJ
NO DO KS / o1.6-6
Building Permit Application. JUL`2 7 2913
Planning and Development Services
PER.M
Building and Code Regulation Division . �,�
S2. Luci� �,e�l�r�t,r, FL
2300 Virginia Avenue, Fort Pierce FL 34982 I/
Residential
Phone: (772) 462-1553 'Fax: (772).4624578 Commercial'
PERMIT APPLICATION FOR: Ke tq0 G•
Address: J i✓ rn J -A N/ 4�1-)b -
Legal Description:
Property Tax ID #• /1- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: W 0 () L • �� Sq. Ft. of First Floor:
Cost of Construction: $ ,4W J O • &-V Utilities: —Sewer _ Septic
Name's 1 Ur &\• " Ku- In I�
Address: l� m i � )61-P U�) y
City: tFfF� I �i�E' Stated Q
Zip Code: Ava Fax:
Phone NoA�� ,Z • D
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County License
Roof Pitch
Building Height: -
Fax:
State:
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY.: _•.Not Applicable
Name: `
Address:
City: State:
Zip: Phone:
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
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 whlch'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 ,'scree n'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 your Notice of Commencement.
$If r Lessee/Contractor as Agent for Owner
STATE OF FLORIDA 1�
COUNTY OF �1: 1) Ci I' .
The o oing instrument was acknowledged efore me
this day of 20 `LIby
U l��ai1.11i42uall�d
(Name of pe,)sr on acknowledging)
(Signature of Notary Ptfblic- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
��, KAREN S. "Nil
`
;= Commission 0 FF
Commission No. °' ) PAy Commission
June 12, 21
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA, 1
COUNTY OF ;
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging)
.(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
_SEN •
} ,Tf - (Seal)
i ion No.
SUPERVISREVIEWOR I REVIEW I • VEGETATIEVI WON I S REV EWtE. I 'MEEVIEWVE