HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'D ' �' � Permit Number: Y10
Building Permit Application MAY 3
Planning and Development Services FERq?,',7i,%5tLucie �o;�n�::, FL
Building and Code Regulation Divisi .on '
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L/
PERMIT APPLICATION FOR: -�Rcnv�- r,.�
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PRQPrOSED INPROVEiM.E LOCATION ., r��y r.. �
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Address: Lf 13(L1 Z Of',?-a :7 zq g,—,/
Legal Description: S.W5,32 -
Property Tax ID#: �catG,- > t /�r7c30 13 00-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DET ILED DESGRIPIION OF WORK Ia } E F
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GONSTRIJCTION INFORMATION
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Additional worK to Be pertormed under this permit-checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Z z /Uitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ gooc) Utilities: —Sewer '_Septic Building Height:
OVI/�IER/LESSEE.
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GONTRAGTOR
Name r LSR k NameZvku".-cch V c,V—
Address:/q 20 z��� ! C�i� Company: -Lv- Qom. ,
City:�77�aAAD Stater Address: 29O/ C17-rC.� k. Nvcf
Zip Code:3 ( S/ Fax: City: -7-7,-RU r 4 State:71'
Phone No.'16 T-13 Z0 Z—' Zip Code�3q?IS-/ Fax: '-e"6-3-d A aZ
E-Mail: Phone No qe=,r-0-5--oz—
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or Younty License(2C(2
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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5�7R�iE)Vl�(�i `A"L C"C'JNSTfUCTION LIEN LAW INEORIUTATIO'N
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 lender or an attorney before
commencing work or recording our Notice of Commencement.
Sign ure o wner/Lessee/Contractor as Agent for Owner S�ilLtor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f�or�oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this" l day of 20_a by this--2L day of WAN 20a by
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(Name of person ac nowledging) (Name of person acknowledgin )
M LAI,(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida/ )
Personally Known ✓ OR Produced Identification Personally Known ./ OR Produced Identification
Type of Identification Type of Identification
Produced Ull Produced — N S. NIELSEN
AREN S. NIELSEN I ;'.� Commission„ FF 115637
Co mi Sion # FF 115537 -" '= Phy Co ion Expires
Commission No. _ "= aa
Commission No. June it 2018
o:
P✓1 lgCii mission Expire; � ';�EovF�°�`'
June 12, 2018
„ .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R 7/2014
ev.