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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I Loo .' ©l o 9 IlwRECOVED FEB 0 5 2010 Building Permit Application PERNUTTING Planning and Development Services St. Lucie County, FL Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 !� Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: (1 , PROPOSED tN� ROUEMENT LOCAT)0N: �1 �_ Address: le6 00- Legal 0 -Legal Description: A&I--~ Property Tax ID#: Lot No. C� Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: I]ETAILED DE�SCR�hPTIO `t3F 1N0 {K: .; coo®ra GI�AF— ZGlu GLd d�z� cr eoNSTR<U TION 1[ 'S Additionalwork to epefformed under this permit—check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer —Septic Building Height: III ®,A 11 R/tLE�SSE�E, RA(,T�OR: F Name Gdbes '4 Name: � r� �� A �� Address: Oa �ac �' .mss Company: G'U-51-t City: State: Address: Zip Code: 31f2e7 Fax: 777—y��— 5— City: State: Phone No. — m- Q Zip Code: Fax: E-Mail: Phone SA Fill in fee simple Title Holder on next page (if different E- I CMF. from the Owner listed above) State or County License c,6te_IZ1- la a—S If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTR 'CTION LIEN LAW INFORMATION: 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. Tht 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 our Notice of Commencement. Signa ur Owner/Lessee/Agent Signature of Contr r/Licen Holder STATE OF FLORIDA STATE OF,FLORIDA COUNTY OF' COUNTY OF The for ing instrumen as acknowledged before me The forgoing instrume t was acknowledged before me this day of 20J40 by this__5- day of 20_14 by 6 ( ame of p on ac owl e ging) (Name of person knowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known_�OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identifi Produced ,•;gar KAREN S. NIELSEN Produced IELSEN ?* t; Commission# FF 115637 =; , Commission# FF 11 637 c= My mf�ission Expires %qF Pad My Commissio Commission No. �`,"reene� 12, 201 8 Commission N f res 11 une 12, 2018 REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.