HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COM PLETED'FOR APPLICATION TO BE ACCEPTED
Date: : 2L N1 o Permit Number: Vr I
CSEr FIVED
Building Permit.Application APR 19 2016
Planning and Development Services PERMUTING
Building and Code Regulation Division- St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: . ��-flC1�L . -
Address:
Legal Description: "010 —,Z
Property Tax ID#: /�?��� ao- Lot No.
Site Plan Name: = Block-No.
Project Name:
Setbacks Front Back: Right Side: 'Left Side:
C 6�
ha+ 8pe
Additional work to be-pertormed under this permit—check:all that appy:
_Mechanical _Gas Tank, Gas Piping _Shutters Windows/Doors
X1 Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of.First Floor:
Cost of Construction:$ r.�e166 Utilities: —Sewer _Septic Building Height:
Name Name:
Address: IS c� e. Company:
City: W �� '�� � State:� Address: , 4'fe,
ZipCode: �:= Fax: ��yy City: ��UU� State:
PhonSe No. �Z' ����Y �� ; Zip Code: S�li'L�f Fax::
E-Mail: Phone No -I?X* - 7 Z
Fill in fee simple Title Holder on next page(if different E-Mail CYr,� r
from the Owner listed above) State or County License Ae-<�O)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: °Not Applicable MORTGAGE COMPANY: _Not Applicable
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.
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,1 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 our Notice of Commencement.
00
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORI
COUNTY OF ��• L.,Uci�, COUNTY OF. zA. E..,uu F,
The forgoing instrun ent was acknowledged before me The for oing instru ent was acknowledged before me
this day of 20� by:. this 1day of. i .201� by
(Name of person acknowledging) (Name of person acknowledging)
(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 y _ i� of identificO
Produced KAREN S. NIELSE+JPrdduced
Commission:1 FF 115637
M Commission Expires ,"„�,,,,�
Commission No. S ��i91' Fes••(Sea Co mission No. 1pRr o�,yr Rwa .mmc eW
;oFF� June 12 24i8 a - ger"�j— –�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA T
COUNTER REVIEW REVIEW REVIEW, REVIEW REVIEW REVIEW
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