HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDq Y7 ^/
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Date:
to Permit Number:
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Building Permit Application SEP 1 120%
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lurie County, Ft_
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED hMPROVEMENT LOCATION F - - -
Address: orio
Legal Description: nf ct �Cl
Property Tax ID#: �/0�"d - �/ Lot No.4,//,
Site Plan Name: ' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION
,:
Additional work toe e orme c under this permit- ec a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
Electric 1:1 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ f' Utilities:11_Sewer E]Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name - VY! C c4-r Name: 01c, -q 46 nC
Address: Company: t c 2.
City: E± eklce State:,?t(- Address: ZC03E 1
Zip Code:�3 y J,5--( Fax: City: F 611 cyr-� State: /
Phone No. T2,44-i-7 f--7-6 JF-d Zip Code:3 Fax: 2 7 d- �{6W- My
E-Mail: Phone No.
Fill in fee simple Title older on next page(if different E-Mail: r� t� UGP fed
from the Owner listed above) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL;CONSTRUCfiQN;Li i tAW tNFORMATtON
DESiGNER/ENGINEER: T Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip' Phone: Zip: Phone:
FEE SIMPLE TITRE HOLDER: M Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie GDuntv makes no representation that is granting a permit will authorize the permit holder to build the subjectstructure
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 CountyAmendments.
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 laying 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,consulttender or an attorney before
commomIffil work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Agent Sighature of Co ctor Icen of er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. Lt j6lr- COUNTY OF
The fo oing instru nt acknowledged before me Thefo oing instru ent acknowledged before me
this day of 20 j j�by this day of. 20 by
7F�
LIL11k,
(Name of person acknowledging) (Name of person acknowledging)
�Ll I.A1 �• ci:q�t V AA 01
,
(Signal re 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 Produced Type of Identification Produced_ jj-
Commission No. mmission No.
AR N S. NIELSEN K� �f�, NIELSEN
a`o""••.;'. -� "% Commission N FF 115637
Commission N FF 115637 _: #;
.- M Commission Expifes-
y „• �, June (2. 2018
Revised 07/15/2014. ''�'9,',:° June 12,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS