HomeMy WebLinkAboutBuilding Permit Application , 1ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r Permit Number: 1� T -
�
RECEIVE®
- Building Permit Application .
Planning and Development Services JAN.1 7 2017
Building and Code Regulation Division PERMIELLNG
2300 Virginia Avenue,Fort Pierce FL 34982 SJ. Lu i ounty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: 2S 7 �U, V-0
Legal Description: 5were,�flaA �qz'� 01117 ME ��� 20 YrJy!
Property Tax ID#: N'P -L,501-CQ 000 -2 Lot No. 2 C
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Ro
Electric _Plumbing _Sprinklers _Generator "' ot
Total Sq. Ft of Construction: 2) d Sq. Ft. of First Floor:
Cost of Construction:$ Cp Z p0 Utilities: —Sewer _Septic Building Height:
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Name -Name: u(-b Afav
- . c- Company: ,e T� ��,�.� '
Address: �-� •� �-,�,' v
City: /�� C� State�� Address:
Zip Code: �:,�;�/(� Fax:. City::�l,�nezy .r ll�i' fcl e,// Stated
Phone No. 7�� -7f`v(� �� / Zip Code:33 5/�'F�� Fax:��c/"32 2
E-Mail: Phone No. �`L��`%��'
Fill in fee simple Title Holder on next page (if different E-Mail:AVZry
from the Owner listed above) State or County License: ' /��73
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:_ 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 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
comynftcing work or recordipg your Notice of Commencemen
ignature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� ZI)C/C-` COUNTY OF ,/
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of—J41W1 Y 20/ by this day of MA411 k y 200 by
(Name of person acknowledging (Name of person acknowledging)
(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 Identification Produced F/-hL r 3S-IV- —;9(LJ pe of Identification Produced FZ OL A&0 17LW��--530
Commission No. _,;:"�"°���eagAREN S. NIELS Nom ission No. ' Seal
�r
*_ ommission# FF 11 637
My Commission Expi UTI U 12 res KAREN S. NIELSEN
, _ •_
e My Co mission Expires
REVIEWS FRONT ZONING SUPERVISOR NS VEGETATIO URTLFjuneMANS®VE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014