HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /'7ry
Date: j � Permit Number: `�
C;E I ITED
• .:.. MAR 0 6 2017
Building Permit Application PERMITTI'NQ
Planning and Development Services St. Lucie Count}, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort pierce FL 34982
Phone:(772)462-1553 Fax: (772)4624578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED tMPR(MMENT LOCATION.
Address: 1�' YI 0 ._edl ✓`'
Legal Description:
Property Tax ID#: 0 Lot No.
Site Plan Name: Q Block No.
Project Name: &ll 1c,
Setbacks Front Back: Right Side: Left Side:
MAILED DIE CRIPTION OF:WORK:
04
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5o
V1-C3 0 3 TV
bona workto a pe m
ore Under t R permit–c ec a pp tat ay
V HVAC W Gas Tank —Gas Piping _Shutters Windows/Doors
_Electric _,,,_Plumbing __..Sprinklers —Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 'T� Utilities: _Sewer _Septic Building Height:
t W1ER/L113SEE« CONTRACTOR:'
Name ,/ ce Name:
Address: 0<3CJ Y% # Company: s
City: Stater Addres 7YQ S.+✓
Zip Code: .` _ Fax: jf City: glcfst L4Lt,e State;
Phone No._ 5�Y� ��3� Zip Code: W9M Fax: L110
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: w+C. S .Aef
from the Owner listed above) State or County License: Cel kzglty
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�. i1Al lNfMATt�
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:
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,1 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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA) , STATE OF FLORIDA
COUNTY OF •Luo,iF� COUNTY OF
The forgoing instrument was acknowledged b fore me The forgoing instrument wa acknowledged before me
4
this day of���1 , 20 4by this U_day of 20 4 by
__L4 A W (L ILL VQnW
(Name oY person acknowledging) (Name of p son acknowledgingC:::�>"
0 AA
)
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(Signature of Notary ublic-State of r1orida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V*1 Personally Known OR Produc
W Identification
Type of Identification Produced L D Lr Type of Identification Produced (, b L'
Commission No REN S. N I E L S E v mission No. n
1tV PSB�
Commis.ion # FF i 156., ��'0.V PV%,
�r KAREN S. NIELSE i
,�� �a
*, *_ F y p ?� Commission # FF 1156
My Commission Expire
June 12, 2010 �;
Revised 07/15/2014
June 1 2. 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS