HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ul-3y'I ��C/ Permit Number:
J �
SCANNED ERECEIVED
BY
BullCpt. ,ie Cgnt_ pP 019
`hermit �► licatioPlanning and Development Services Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: q q'/ J A� A14 (A'+ 19-
Property Tax lD#:1Lq)Lf tp0�. 60o�,Ooo 4 Lot No.
Site Plan Name: 11 L K%nney Block No.
Project Name: M G fk.'^e
4-ew 1,y145 14rcl tte .
Additional work to be performed under this permit - check all that apply:
_Mechanical
Electric
_Gas Tank
7' Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ o 00
—Gas Piping
_Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LE-SSEE.
CONTRACTOR:
Name 5Li5o'n
Name: oh
Address: -IH YR� '4 1 r+- L4�. yD-
Company: t nr h
o - .
City: _ Fo- Pierce State: / I
Zip Code: 3`fq yy Fax:.
Phone No.
Address/: PO . (o5-09 6
City: ro gQ.gc State: r%
Zip Code: 39L96 G� Fax:
Phone No -?Va...I......
E-Mail: - ......_ ._.. .,.._..
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 6--Cvj".w con51r {I on (2 v9 6too o r✓'\
State or County License (_ ( �-i (01 `i a
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.
r
SUPPLE ENTAL CO NEtU
DESIGNER/ENGINEER: _
Name:
ON L E LAW I
Not Applicable
FOR ON:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:,
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 holderto 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, 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Conti ractor%License Holder
STATE OF FLORIDA`
STATE OF FLORIDA I 11n
.
COUNTY OF I� J(', I Fi
COUNTY OF
The forgoing instrutnewi was acknowledge efore me
The fo going instr ment was acknowledged efore me
his ( dayof 20Wby
hisIdayof�' _ 20_by,
1TAt.�1(1 - IAlplI►,�A Ill
�\T(�6,10 C-���R�I�IIA � l I
Name of person making statement. /
Name of person making st—atement.
Personally Known ` OR Produced Identification V
Personally Known OR Produced Identification ✓/
Type of Id atio
Type of Identif caYaen
Produced
Produced
(Signatur a
(Signature of Notary
,o„„Yo°a, KAREN S. NIELSEN
, F: State of F 1pg�dgNotary'Public
KARE
o•1w+n�o. N S. NIEL$E,N
Commissi ��=State of Floritla-Not blic
Commission No.
=' ommission # GG 207484
=n
MY Commission Ex ims
Commis on GG 207484
3:�0 �?; My Commission Expires
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