HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'T�11 Permit Number:
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.M::..� Building Permit Application JUS 2 4 2917
PERIN111 i 1i IG
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 COCYII'1'tercial � Residential
PERMIT APPLICATION FOR:
Address: 33 as N • LEw'1 �.(rA�• ��. �1 �� 3��`(5
Legal Description:
Property Tax ID#: ��{LS Z ZD o 00 l - o oa/l Lot No.�_
Site Plan Name: Block No.
Project Name: 1 J A, U O"t"
Setbacks Front Back: Right Side: Left Side:
.p- ��L O ✓I r G�DPW rLrX "�- OLLS�L �!. '®Cad l LV4 ate!_ e
1.17 U f k, C�-��.at 2 L'"'V$e--
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Additional work to be pertoMe under t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of-Co nstru tion: Sq. Ft.of First Floor:
Cost of Construction:$ / Utilities: _Sewer _Septic Building Height:
Name KLPI KAVY La b r Sri- LtiV6660 NameJ— it I ST
Address: 3i6o d(!. A I.A, Company: 6PUST L'CAJ5T20 ( IDN C�
city: State:`Gc- Address: 43 T'-.`e- Lli ,
Zip Code: 3 LHA-01 Fax: '111 �`i S- Of city: 4::t- g0ii State: �-
Phone No. -111- • 5 ct5 - S 914 S Zip Code: 3 Z Fax:
E-Mail: a_ iALt. v MA o r Phone No
Fill in fee simple Title Holder on next page(if dif Brent E-Mail 1 V►� 4_uo o' CZN-`-
from the Owner listed above) State or County License Ct,L ()4�td
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: i Not Applicable
Name: Name: /—
Address: / Address:.
City: /" State: City: State:
Zip: Phone Zip: —Phone:
FEE SIMPLE TITLES HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: i Name:
Address: Address: /
City: /. City: —'
Zip: P� fie: 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 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 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 atur of Owner/Lessee/Contractor as Agent for Owner' Signat of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 57, COUNTY OF
The forgoing instrument was acknowledged before me _ The forgoing instrument was acknowledged before me
this4!t
�day of 'w y. ,20jJ by this day of .ry IL ,20IJ by
�+AmFR bA O-J"
(Name of person acknowledging) (Name of person acknowledging)
(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 Identific ' n Type of Identification
at
Produced Produced ELI O-L
"� �P KAREN S. NIELSE I
tipKr v y�
Co mission No.
Commission No. r. ';=(Seal),mission t FF KAREN S. NIELSEN
do My Commission ���Pw' Oa(`�
E x p i r s
,acv v` Ju _ c Commission# FF 11563
y ommission xpue
J u 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW __REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.