HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I`1
Date: Permit Number:
JUN
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Building Permit Application Lucie '�ounty
- b' pp St. Lucie County, FL
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 v/
Phone. (772)462-1553 Fax. (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: L
OWN,
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P.RQPOSED IN°PhRO\/EMENTL�CATIQgN § F ! , # t#wl
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Address: 170 1'� 11 iurE , PIS[1 9. 3+9SK
Legal Description:
Property Tax ID#: Zt O"Z- U`-'`-'- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OFORK
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f�ErLAe-F oUD R15EK W(RC-5 - R1f-=PLA er-- Mn-9Z , I0T WOSRHEQ I'F M5-C-R,C J
W&5 W60 If- )31�1� LASE
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Additional work to be pertormed under this permit-ch—ec-k 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:$ "I`'�� Utilities: —Sewer _Septic Building Height:
UVtNER/LESSEE ECO.NTRACTfl`R
. .' tior a _ .� :.. «
Name I-KM-T9AQD oyLr-- Name: TAY l EVY;
Address: 1'707 Ade' Ayr—, Company: 4w6 �fz(L LUL
City: R, plaxe State:FL- �7
Address: 660 wb* p`)AID t�
Zip Code: 311$Z Fax: City: 9 PI$Zrc State: f L-
Phone No. Zip Code: 44951 Fax:
E-Mail: Phone No 0772) 5M- `�
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Fill in fee simple Title Holder on next page(if different E-Mail 5lVs04--P rN5 P-YRV1Cb.C6M
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S i'PLEI\/IENTAL CONSTtIJCTI®N LIEN L.�W INFO'RNIP►TION:
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 rppordirIg your Notice of Commencement.
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Sign atur w er/Lessee/Contractor as Agent for Owner Signature ofRyac*License Holder
STATE OF FLORIDA q 1 STATE OF FLORIDA
COUNTY OF , ` �l ,1�, COUNTY OF l
The forgoing instru pent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 11 by this day of 20-a by
A
(N aYn e o )on a knowledging) (Name)Df p�A n acknowledging)
C9-- 4 A \ cJ—�
(Signature of Notary Public-State&f'Florida (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification +/ Personally Known OR Produced Identification
Type of Identific do Type of Iden
Produced �,�-- roduced
—KAREN S. NlELSEN
KAREN F?E N S. N I E L S E PI
r raven CU lis ion# FF 115637
o �4=
Commission No. _ (SSlsah))ission :k FF 11563 mmission No. � t � M ��ission Expires
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My Commission Expires I <4FF June 1 2, 2018
FF June 12, 2018
,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 4