HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�
Date: �1\yl n Permit Number:
RECEIVED MAY 10 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED 1N
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Address: 11`7 ti-zgLk-cc S�-
Legal Description:
Property Tax ID#: -L.-)y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEl'AII,ED DESCRIPTION OF WORK MaN
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CONSTRUCTION INFORMATION
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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: $ L\OCl`,(3 d Utilities: —Sewer _Septic Building Height:
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CONTRACTOR
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Name 6 vk -
Name: .,
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Address: �h , Company: .Po\AA?-Y'\ Gna Sa1S
City: N-A L IA C. State:r�o. Address: �l°I�
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Zip Code: 32-193 Fax: City: �"y's State:
Phone No. Zip Code: Fax:
E-Mail: Phone No \
Fill in fee simple Title Holder on next page (if different E-Mail �� t� W� c'���Szn p d Carr
from the Owner listed above) State or County LicenseC`gC,12592 OC)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPEf1/t13`�LONSTRUCTION.LIEN LAW INFORMATION
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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 le der or an attorney before
commencin w k or recordingour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for OwnerSignatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L 'O'I COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \o day of TI 20_n by this k6 day of V%" , 20by
Vll. \N � C-11,11)� S�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary Pu lic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification y a Type of Identification
Produced ` ��— t Produced ��'oy., DEANNAMARIE GNENS
p[AIVNAMARIE GNENS =o:
, g{ON# 021023 M�Y,rCOMMISSION#GG 022023
Commission No. _. y =:0 MY�QIe�mrG6 2020 Commission No. 0=1�r PThN�ary% derwriters
=*i Ex {{jj�� u PublicUndenvrii°rs 'kGFF�o Bon e
BondedThnrNotary' '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014
Planning&0evelopnientSen►ices ASBESTOS NOTICE
.Bu l.ding&Code Regulation Divislon_
2306 virginia Avenue;
FortPierce,FL..34982...
Phone:(772)462 -2172 Fax:(772)46Z6443
Asbestos Notice to Contractor
May 10, 2017
PAULSEN &SONS CONTRACTING INC
KEITH M PAULSEN
499 SW DAIRY RD
PORT ST LUCIE, FL 34953 FILE o r'n
RE: Building Permit Number 1705-0214
It is your responsibility to comply with the provisions of Section 469.003, Florida Statutes and to notify the Department
of Environmental Protection of any intentions to remove asbestos when applicable in accordance with state and federal
law.
Signature
5/D-/7
Date
5/10/2017 10:53:31 AM