HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 (�
Date:.3 '2q' 1"7 Permit Number:
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Building Permit Application MAR 2 4 2017
Planning and Development Services PERrAITFING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
PROPOSED I'NP011 MT, Nl IN L00ATIO:N:
Address: 12. 'Y u c.<_ a X*-N V e,
Legal Description: L bj 12 , _810e_k 111 ^l�c.(``L'�
_P( L4- iiaak lD , ( 22)s_ f y
Property Tax ID#:1L(0-,)--- (DID - -E>(Q(-1 ec)0_ 1 Lot No. (2
Site Plan Name: Block No. I
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'ETAI I:E�D 1 CSCR'OPTION OW®.RK:
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C®NSTR�l1CTl'ON IN!FOR�IUtATIO'N.
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: ;
Cost of Construction:$ 2 6 a Utilities: Sewer _Septic Building Height:
01NNL'R/LCONTRACTOR:
Name L) C_0A�, r Name: SG M Q
Address: (Du12 Vu--,--Q Dr-"yeCompany:
City: state:-1�L Address:
Zip Coder Lf'-?8 Z_ Fax: City: State:
Phone No. 7-7 2 Z2-4 JI 8'�'t Zip Code: Fax:
E-Mail: ncz-3 rn.orn^.k Ke !2M-,S a. —Q 64 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI:®N LIEN RAFEW INF®RMAT(
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. otice of Commencement must be recorded and posted on the jobsite
before t e first inspection. If yo int nd to obtain financing, consult with lender or an attorney before
corimeqlcing work or recordindyodr Notice of Commencement.
Si natu a pf Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF • �� <-� COUNTY OF
The forgoing instrument w s acknowledged efore me The forgoing instrument was acknowledged before me
this day of 20sby this day of ,20_ by
(Name of person acknowledging (Name of person acknowledging)
r
(Signature of Notary P blic-State of Florida ) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifi cation Type of Identification
Produced
C'' REN S. KIEL ENommission # FF 1 5537Commission No. `� alf Np?ed Psion No. (Seal)
My Commission Expi
OP« June 12, 201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014