HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (Q�
Date: -7Permit Number: jrj� nos� 1
Building Permit Application FEB 2 7 2017
Planning and Development Services PER114j'rT)Nr,
St. Lucie Count•'s
Building and Code Regulation Division , FL
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential C/
PERMIT APPLICATION FOR:
�� rC �
PRO OSED INPROE�MEN1' LO:CAT ON:
Address:
Legal Description: �S �{V �0 ��
SF /V Or sw f/y Of s_p Gess C I* C R r Q ,v h,
Property Tax ID#: 97 a 13 y � �- ��Q �Sr Lot No.
Site Plan Name: p", Block No.
Project Name: (N('AddW rPy��QC2���
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCR�IPTION .OF WORK: -
QCQur��,>L (Ni'iqdo y^ 'l Yz dtr QC� rC
CONS�TI3'IJCTION. IN`FORtX/IATI®N:: -
Additional work to be performed un er t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters 0 Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: 0,0 Sq. Ft. of First Floor:
Cost of Construction:$ S-1 �/���� Utilities: —Sewer —Septic Building Height:
01N E /LE-�S�SEw
C®NTR��'CTO�R:
Namef/wff L4 V✓lName: NvAk 29i-✓0 Ocf 'Os
Address: 5000 h Company: dvqACE¢/ �v✓v,'CG e- ''�i'
City: VC�- E�r�i-C�� Stater Address: CD&(V1'01 A/t/
Zip Code: �R 7 �. Fax: City: 5-71(./Q,✓ State:±t
Phone No.(�7'/�) q -7 f- y7/ Zip Code: 1 Y?911 Fax:
E-Mail: W 0(0 1 So bz(Nv/�. Mt*_ Phone No 7-704-
Fill in fee simple Title Holder on next page (if different E-Mail )t Olt 11 10 0dv0PA0 d A vvv,CO,rR
from the Owner listed above) State or County License 0-9'a
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW I�1F0'RI�/IATI®N: R
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 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 N tice of Commencement.
Sig tur _f O ner/Les ee/Contractor as Agent for OwnerS6001
Contract /License Holder
STATE OF FLOR QA STATE OF FLORID
COUNTY OFICAV, COUNTY OF LU
The forgoing instru t was acknowledged before me The forgoing instrument-was acknowledged before me
this Q3day of20+ by this day of 20�by
_ e4Pe OJA I 1O AL) Z'&-eve o a
(Name of person acknowledging) (N me o person acknowledging)
tl1
(Signature of Notary Public-State of Florida ) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification y Personally Known OR Produced Identification
jType of Identification Type of Identifi ation
Produced Produced L'
" KA 2 NIELSEN
\1TRC
P.
i ;, /
Commissioff��#�FIF, 115637 Commission No. s+ `"�C,-s• KAf�EN(Se� ELSEN
Commission No. _ *= commiL'Zg9 Expires
ey ; 6mmission # FF 115637
June 12, 2018 My Commission Expires
01 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Fe-v—.7/2014