HomeMy WebLinkAboutBuilding Permit Application (2) . � t f s x n
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: 1,4
Address: Address:
City: State: City: State:
Zip: Phone Zip: one:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: o e:
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 thepermit 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.
Signature of Owner/Lessee/Cont r ct r as ent for Owner Signature of Contractor/Lice se Hol r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrumen as acknowledged bef a me The forgoing instrumen as acknowled ed before me
this day of 120 b this day of 0_ by
VAG \t� OAIT44A u6\3A oic L
1A
(Name of persoiN acknowledging (Name of persoh acknowl gin
iAl JA
(Signature of Notaryublic-State of Florida) / (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identificatio Type of Identif' ation
Produced (.._.b. ""' KAREN S. NIELSEN roduced
KARE
*_ Commission u FF 115637 � ''""°���•, S IELSEN
Commission No.,. �, 93mmission Expires ommission No. AF Commis � II FF 115637
June 12, 2018 =�
Q' :���; o,�r My commission Expires
' June 12. gnin
REVIEWS FRONT r,20NNG SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 4
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y�
Date: I�� Permit Number: h lJ
Building Permit Application NOV 9 p 20%
Planning and Development Services PF � T.
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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:
PRO�POSE�D INPR®,1IEMa KNV, UO ON I®�N
Address: % �/70 L- ,Dr;ZIF
Legal Description: � h qy-a ton P lA zq - Uig I+ r'du2 k0af hf
Property Tax ID#: / �' ��7 — PDJQ0Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be per orme d -un er this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator �.rJ klonoof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ a Utilities: —Sewer —Septic Building Height:
OW�1ER LES SSE : 0i" CONTRACT®R':
Name
Address: ifs"� V• Company:
City: � .... .`e�,C�` State:_ Address:- C
'�jt{.G�` �y �+2706 7:6 Atlantic Me. tate:
Zip Coder � 1" Fax:�F�� City:
Phone No. 7
�7 *-t II-- Zip Code: � Fax:
/
E-Mail: � "O 1 1 /0 Phone No -/ 7 - Aq� r9/§— ,�,�p
Fill in fee simple Title Holder on next page( if different E-Mail ir'0 CC9 ('J C as I��1
from the Owner listed above) State or County License D,ri
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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