HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: - �l L l) _�� Permit Number: nt
RECEIVE:D.
Building Permit Application LIAR 2 0 2017
Planning and Development Services
NG
Building and Code Regulation Division PERf��ITTI
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: 1
Address: ;: a!S mc— 9'r-Cna e n iu �ri_ST LJIJL.C1-e . I:—L Z—M q 83
Legal Description: 32S IrU� e���� 9-a QorTS� LSC 4 Q'3
F. k V4-Ir Pa.,-k- kY��-V ot ?OL-14 C. kS 1 I(, FS Z 1_1 r 3
Property Tax ID#: 19 - SrW- CAa 3- Oo 0 -S Lot No. 3
Site Plan Name: Block No. 9
Project Name:
Setbacks Front OW Back: Right Side: 0 LeftSide: N b`
DETAILED DESCRIPTION OF WORK:
.:Dn54,x�,k (9) ,P,>rrk," SNLJJx-f'S do r, 4 o/-A-C
CONSTRUCTION INFORMATION:
Additional work oe nerformed under this permit—check a appy:
HVAC0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �L00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name _�J_a Name: D CkV L Ct i= ter
Address: 3QS Nlr Rrctek-en &A Company:
City: State:_r—t_ Address: S
Zip Code: 3"q3 Fax: City: mar± State:-El—
Phone
tate:_Phone No. Q t)(g • U 9 S1 Zip Code: 3LA r1$ Fax:ASe 1 _303t
E-Mail: Phone No. .. `13-o F-os
Fill in fee simple Title Holder on next page(if different E-Mail: 1S0LAA't'L. illl`e-�
from the Owner listed above) State or County License: C6C_ 1 ;LS 1_)Sc1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ of 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,I do hereby agree that 1 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 resultyour paying twice for
improvements to your property.A Notice of Commencement must be recordedAd posted on the jobsite
before the first insp ion. If you intend to obtain financing,consult with lend r r an attorney before
commencing work/6r recording our Notice of Commencement.
" s
Sig=EOF
ner essee/Contractor as Agent for Owner Signature of actor ns e Holder
STORIDA STAT F FLORIDA p
COUNTY OF� . �U(i�l COU TY OF :tl)OA,
The forgoing instrument ras acknowledge
% d me The forgoing instrument w s acknowledged before me
this,26„day of MnYo I& 20 by this day of 20 IL by
(Name of person acknowledging (Name of person acknowledging)
in jA q,
AA
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of lorida)
Personally Known OR Pr ed, dentification Personally Known OR Produced dentification
Type of Identification Produced Type of Identification Produced
Commission No. ission No. (Seal)
""" REN S. NIELSE
�i�'R\PLE/nen
Commission# FF 115 37 \"""'�, KAREN S. NIELSEN
a Q; �Y �= ommis
Revised 07/15/2014 �rEUFi\�F\ June 12, 2018 =s E My Commission Expires
'/Ill ltl\\' 'moi'lE �`
June 12, 2018
'VIII III\\\
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
1