HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf f ,
ALL APPLICABLE INFO MUST BE COMPLETED F�'RPL�LI�R+�'6�1� "f® i�F ACCEPTED .1�
Date: 1:'19' Permit Number:
SCANNED
BY St Lucie County E��i ��� ,
Building Permit Application DEC � �
Planning and Development Services 20I7
Building and Code Regulation Division PERNIIITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie C ;,ty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: IS°l ?eOPe/ &Ae , -,�nSen 3eCCr
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Legal Description: Ore- LO.+ z (ap, clocf-283)
Property Tax ID#: '�s�i'-SU3—OC���--Ct?d- Lot No. 2,
Site Plan, !Name: Block No. _
Project Name: I P)Omc, _
Setbacks Front rJ/4 Back: .E ' Right Side: O' Left Side: 101 _
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Additional worktobanerformed under this permit — check all tnat apply:
OHVAC Gas Tank ❑Gas Piping _ Shutters IE"Windows/Doors
Electric Plumbing E] Sprinklers 1:1 Generator ZRoof Roof pitch
Total Sri. Ft of Construction: S . Ft. of First Floor: _
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Cost of Construction: $ _ Utilities: 0Sewer OSeptic Building Height: f
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DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name•
Name:
Address: G50 ScJ Sc�l�nJn
Address:
City: f�.} S�+ Luc�E State: f.
City: State:
Zip: ,3kGS,;_ Phone A-21
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 authoeize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association bylaws that
rules, or and covenants 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
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 attorne before
commencmg work orwwording.Vour Notice of Commencement.
r 1
§gfatu[e of_Owner/-Less ontra or as Agent for Owner
Signalwelof Contracto c nse
STATE OF FLORIDA L
STATE OF FLORIDA
COUNTY OF ;� �(���
COUNTY OF
The f r ing instrun ent was acknowledged before me
The for oing instru ent was acknowledged efore me
thisday of 20 by
this day of 20 by
eKA
Name o person making stateme t
Name o person making statemen
Personally Known OR Produced Identification
Personally Known __ .MProduced Identification '✓
Type of Identificat�ioD
Produced
Type of Identificalim
Produced L
i ,.9,
r C_S
,
(Signature of Notary Public- t
(Signature of Notary Public- State of Florida )
,,,e�,, KAREN S. NIELSEN
,
Commission No. - mmissiAeg3l�F 115637
Commission No. ,,�;`a: oJB., K� S. NIELSEN
%a # FF 115637
._
- - My Commission Expires
June 1 2 2 01 8
m: Co mi ion
=* *' My Commission Expires
=
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F ,
12, 2018 .'f�ff�June
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Rev. 8/2/17