HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,2. '1-3 7 Permit Number: 11 L
�- R, ECEI E
Bui[di ng Permit Application FEB 2. 3 202
Planning and Development Services PEWMiTTIVC
Building End Code Regulation Division St. Lucie County, FL
2300 Uirginio Avenue, Fort Pierce FL 349,32
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM fTAPPLICATION FOR: Gl� g,d�0✓I
— Iss
Address: 3� � CS S--P� -
Legal Description:
Property Tax ID#: I (�10 S ® 10 v/ UUd
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side.: Left Side:
_ r�"�-t.#JY 31 Rti _ :rt7L7-•)".����"�•� .-��, eyy���"- '"'�•--Px 7'-'. � ��'-..s�r �`..
A6*5[56nal work to be pertDr-med un er this permit-check all that 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: C), (l U Utilities: Sewer _Septic Building Height:
U,4Ff E ' 'E55�, �� � - "• —__' CCTTE Q� r
Name C"�ely✓�- �.�r�"V 45 Name: ./ �S `la�,�50�
Address: 303 Company: �� S �c Lc>� - dI^Sti^
City: rrren, - ' Stater Address: /70) Sd 37 S�
Zip Code: 34"cl Ll -CFax: City: P. Stater
l��
Phone No. `�/- 62,!ct Zip Code: ?q 1 ,11-7 Fax:
E-Mail: Phone No/77
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner1isted above) State or County License
if value of construction is Z500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not.Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: Cite: 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 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 Raying 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 wok or recording our Na 'ce of Commencement.
Signature of Owner/Agent/Les e/Contractor Sign re of Contractor/License Holder
STATE OF FLO I A STATE OF FLORIDA
COUNTY OF �(�� , COUNTY OF
The forgoing instru nt was acknowledged.before me The forgoing instrument was acknowledged before me
this day of 20a by this day of 204i(by
(Name of person ack owledging (Nam o personLigi nV)
A. 0 AAch
(Signature of Notary Public-State of Florida ) (Signature of Notary ublic-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Ide of ion of IdentffL
-cation -
Produced KAREN S. NIELSEINPro uced -
<AREN S. NIELSEN
3= ", 'Commission FF 115 37 :�_° °`�: Commission# FF 115637
c N +c
(Seaf�Commission Expireto iSSlon No. My Co(&8�@i�ion Expires
Commission No. '�9�F°F« June 12,-201 8 oN;F °
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I I r
Rev: 14.