HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�. �' Jr
Permit Number: ��
RECEIVED
DEC 2 8 2015
Building Permit Application PERU11ITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Residential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR 77777777-'77 07
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Address: Y. ia� N le.it
Legal Description:
Property Tax ID#: ,��/O/ g4/" l'7�� —CLdo/ t� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks FrontT�� /'Back: Right Side: _Left Side:
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pyCECRILY
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40
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Ad itiona wor to a pe orme un er t is permit–check all tat appy:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator —Roof
Total Sq. Ft of Construction: Z/��� Sq. Ft.of First Floor:
Cost of Construction: $ � `�o� Utilities: _Sewer Septic Building Height: p
Ctly9n ) CLT x-
77
77, �
Named Name:
r: )
Address:
`i;Mt t c Company:�i1�K7 [,.�� � �
City: - rt State: Address: .3�/� lrl j✓c,.� �^�L�
Zip Code: Fax: City: -�'`e Stater
Phone No. Zip Code: 35/�/'S .' Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail �-
from the Owner listed above) State or County License /
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: 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,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 attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contra df-or/License-Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 0,ne COUNTY OF Oil 11)0,1r.
The f ing inslLrument was acknowledged before me The Ping instrument was acknowledged before me
this May of 26L5 by this day of 20J-157 by
w� +�P60J
A
lame of person knowledging (Name of person acknowledgi
(Signa ire of (Signature of Notary Pub Tic-_'State of Florida
Personally Known OR Produced Identification Personally Known_OR Produced Identification ✓
Type of Iden reatio of Identification
Produced KAREN S. NIELSI wrod iced
Commission#FF 115537
-brr I n
Commission No. eaMy Commission Expi,r n No.
June 12, 2018 issio
Commission#FF 1 63
My Commission irei
June 12, 2
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DATE
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COMPLETED
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