HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h _
Dater i'�l �"` Permit Number:
Building Permit Application NOV 14 2
016
Planning and Development Services
Building and Code Regulation Division1' s=+' f F i ING
2300 Virginia Avenue, Fort Pierce FL 34982 i"' ���=.Gourity, 1=L:
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: I t s 4JE—rT-2-0,$ /i Ly 0 SZ-,U Fes. 3 `f c7 S-/
Legal Description:
Property Tax ID#: .S D Z SU/ G 5-9 �'j O OG Lot No. 13
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRkIJC�TION
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Additionalwork to be pertormed 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: �;OZ Sq. Ft. of First Floor:
Cost of Construction: $ l 5-067 ) Utilities: —Sewer _Septic Building Height:
OUtNE 9ESSE x � h<{C()NTR/�
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Name N vAi"G �r(/L.-(/-jy Name: Y%,&Ua
Address:- Company: .-lfV7e&z-«•0-- Pk, Li
City: 7,7r �V$”G State: l� L, Address: /Z9 o i � -y�3 us.a s v JZ Er
Zip Code: 3`f,�f Fax" w 5 c:WJ Stater L
Phone No.` c( '2 ' rot' � c-( 2( Zip Code: - = - ti 9 5- -7 Fa)x ?
E-Mail: Phone No -7 ? 2-- 3 "3 Y - L4 3-3
Fill in fee simple Title Holder on next page (if different E-Mail IZ F Ns '1 8( S @ A-C, , C owt
from the Owner listed above) State or County License C C- O
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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PP�L4E�MEN�}�L.CONST CTF T N!20 I`NEOFii1\11/OR IN a:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: t Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Pho Zip: Phone:
FEE SIMPLE TITLE HOLDER: icable 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAL` STATE OF FLORIDA
COUNTY OF��J ,�1C�.1 7 COUNTY OF
The forEping instrurneint was acknowledged before me Thefor oing instrum nt was acknowledged before me
this day of ® 20_W by this1�-r day of20 LI t,by
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(Name of person ackn wledging) (Name person acknowledging)
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(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 Identif on Type of Ident' tion
Produced ( Produced (� c�•�.:
Commission No. (Seal) Commission No.
KAREN S.. NIELSEN fn KAREN S. NIELSEN
*_ Commission#FF 115
. 637
� , -.�;rEOF' Po�c Y ornmis_ ion Expires
M Com fission Expires }2
REVIEWS FROM ';�-.o ,.,y31VING P �SOR PLANS VEGETA MPOGRO
Jun 5V, �&
COUNT REVIEW REVIEW REVIEV-7-- 5 WJ
J1
DATE
RECEIVED
DATE
COMPLETED
Te—v.7/2014