HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR,APPLICATION,TO BE ACCEPTED
Date: �aq' llo Permit Number: E(C
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AUG 19-20 1
Building.PCrmlt Application PEP►,gITTING
Plonningdnd:Deve'IopmentServices 5#:Lu'cie County,`FL
Building and Code_Regulation Division .... . .
2300-Virginia.Avenue,Fort Pierce FL 34982. .. ... . _
Phone:(7-72)462-1553 Fax: (772)46271578 0011' mercial -• • Residential
PERMIT APPLICATION-FOR: - _
Address a'�f 0f.�
Legal Description::VQres/ /0�/9;c#9: V I.Vl 0, Re PL,11'r- .4a. J. C k_l T 6! H 1 e Y--
Property.-Tax)[)#: /��3��.i. ". �.�� f d� T �f v(3 Lot No. _
Site Plan Name: .. .. Block iVo.
ProjectNName: /Vex/' /{/dd d e.
Setbacks. . Front - Back: Right Sid'e:` �'LeftSide _ -
Avelyt< u-" Al- �a9 T�'
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1111ifiSZR, _.: Wil
AdClitional work to be pe Orme un cler this permit—checK all tat 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:$ 6!dA r�d Utilities: _Sewer _Septic Building Height:
Z_-
Name �//�'/(l. "�/ es it/%S 1 C Name
Address: Company: e
City %r��/ii�,�P Sl Address
Zip;Code:� �d 5S"�l/fax: City �I°" Stater
Phone„�lo. Zip Code: Fax:.: ngL�9o�
E-Mail: Phone No
Fill in fee simple Title Halder on-next page(if-different E-Mail
from the Owner listed above) State or County License ”
i�.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required-.
DESIGN ER/ENGINEER:_ Not Applicable MORTGAGE COMPANY: Not-Applicable-
Name:
ot-ApplicableName: 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
pply: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 followingbuilding g permit applications are exempt from undergoing a"full co►icurrency review:room additions,
accessory structures,swimming pools,fences,walis,.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.:-
Signatur f Owner/Lessee/Contra 'as Agent for Owner Signature Contractor/Li ense Hol
STATE OF FLORIDA STATE OF FLORIDA
+. COUNTY OF o �)(�1��
COUNTY OF I
The forgoing instr ent was a knowledged before me The f&going Inst en was a knowledged before me
this day of 20 1(p by this day of 20�by. .
AUfzu �,
(Nam of person acknowledging) (Name of erson acknowledging) `
L ,
Si nature f No a ublic-St F
. (Signature of Notary Public-State of Florida) ( g o try ate of Londa)
Personally Known - OR Produced Identification Personally Known OR-Produced Identification >✓
Type of Identificatio Type of Identification
Produced Produced
L
'%tool" KAREN S. NIELS
Commission No. ,® ealbmmission x PF 11 6 ission No.q— ,`"'..,a,
•..
My Commission Exp res ;•' '`�= KARE
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w o _. S.
June 1 _ co NIEL N
OrnQui.•' M C F.1 1 g
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION :►UA Epir s
COUNTER REVIEW. . REVIEW 01-8
REVIEW_. _ .-REVIEW.... REVIE _.
DATE......_
RECEIVED
DATE
COMPLETED
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