HomeMy WebLinkAboutBuilding Permit Application ALL APPCAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: n Permit Number: I �V
Building Permit Application MAY 0 3 2417
Planning and Development Services
Building and Code Regulation Division P E RM FrT,i�lGSt. Lucia 'ounty-, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: R 864-cin
Legal Description: "Ll S
Property Tax ID#: 3334 ' 501 —d ) "'001�)-o o Lot No. )
Site Plan Name: Block No. b
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CO�IS�"RUCTION INF�O(�lyl TION � �5r�� ,�
itional work to be nertormed under this permit—check all tha appy:
_ AC Gas Tank Gas Pi in Shutters Windows Doors
❑ Pg ❑Windows/
Doors
Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction:� S Ft.of First Floor:
Cost of construction:$ T � UtiIities:Cn Sewer Septic Building Height:
g'i+'a, v45 4 � ell
.,,+
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�ranr'ifi't..,_a3.�>,f3. ,u7 ,t....S - �,te �eNAi ut,-�a3?.:.a kin.-�`.�'.a' r.Eo
Name kea Name: �;� ,��,a- �c.rrac�
Address: qYY\ S\r\e r A- cin' Company: h�m�si r_ 1 ',r Cc rej
City: State: ( Address: 54r N wY�esY n �� �� S' W7
r
Zip Code: �4�11�'7 Fax: City: State: F I
Phone No. o17P, 14y — i'�S2- Zip Code: YA016b Fax:
E-Mail: Phone No. '7-72 -311e-0093
Fill in fee simple Title Holder on next page(if different E-Mail: C\nr-)s co M
from the Owner listed above) State or County License: C OtLD S'7 4 8 i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
k� .RP��MENT ►L�°��mNSTR: GT�N�LI;� � UU� FARM. :: �f3N�f �� � ,{ �.°`'�<� �- �yW� ;�� �°�'.,�,,��LjS�A+tipa
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 thepermit 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 O OWNER:Your failure to Record a Notice of Com encement may result in your paying twice for
impr a ents to your property.A Notice of Commenceme t mu recorded and posted on the jobsite
bef �h'e1first inspection. If you intend to obtain financing o ith lender or an attorney before
co n'in work or recordingour Notice of Commence e
s
ignature of Owner/Lessee/Agent Sign ure of Contractor/License Holder
STATE OF FLORIDA t STATE OF FLORIDA 1 , ,�1�
COUNTY OF ,l1(',IF� COUNTY OF LJJ J
The f going instrument was acknowledged before me The fo oing instrument was acknowledged before me
this y day of 20�by this day of 20 by
(Name of person ack owledging (Name of person ackno le^dging)
tiY II ..
AA
(Signature of Notary Public-State of Florida) A/ (Signature of Notary Public-State of Florida)
Personally Known OR Produced I entification Personally Known OR Produced Identification
Type of Identification ProducedType of Identification Produced F_71 n•41•
Commission No. �C° fission No. (Seal)
��Qo1pRY P0U�` I<AREN S. NIELSEN4 --- NIELSEN
?e �_ Commission l FF 71 637 K ",'p'/ KAREN S• 7
� �F ` Ay commission
,Eoin r ommission .
r Ex i
re'- " un 2oia
Revised 07/15/2014 june l2201S
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS