HomeMy WebLinkAboutBuilding Permit Application AI,.I.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED , tA l t �rr�
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Building Permit Application JUL I
Planning and Development Services PER:1ITTING
Building and Code Regulation Division Si. Lucie County,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED CNP`ROVEIUIEENT LOCATION
Address: 6 -5-o C)od yo,2r-e W .IAI f )910YC-PI
Legal Description: to X i L/ SSI eco
Property Tax ID#: /3d/Y C "C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D5CRiPTION x FINORKs ;5 3t
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CON$TRUCTION INFORMATION
Additional work to be perfo—rmed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: I -'10_5qF Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
O�NER/LESSEEr ex CONTRACTOR
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Name q,hC4 ,rV/t- Name:
Address: (a S 0 5 WUad_3 Pt-PSC Company:
City: Fr Pre YU State:F/ Address:
Zip Code: S Fax: �I City: State:
Phone No. 7V2_ 7 C/ 3 //V g / ___ Zip Code: Fax:
E-Mail: ra 45,E id r U S (N 010�. co il►- 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.
up�aEM N4TA�coi�s-rRucTioN r N Y cru vFORnnAT�oN
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DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: v'� 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 our Notice of Commencement.
* \Z4
Signatu of Own .(/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this cr).J day of 20I LQ by this day of ,20_ by
(Name of persbn acknowledging) (Name of person acknowledging)
lt'-�Oj,w I. tl&Itg
(Sign ture 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 Identific tion Type of Identification
Produced G �.. °� �- d ced
aa. KAREN S. NIEL JENCommission No. - a6ommission# FF 11ssion No.
(Seal)
te. y Commission Ex
''moi„OF il�P••�
June 12, 201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.