HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number..:
V -
Building Permit Application AUG 2 2- x011
Planning and Development Services PER.M1i71NIG
Building and Code Regulation Division St. Lucie County) FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: I� J
PR�OPO- ED IiNP'ROVEMENT LOCATION:
Address: a(Q � S d�!'�CG�SM+ h P2rJP:
Legal Description:
Property Tax ID#: J3 ad- Cot - Od#d -000 - 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'ETA LED Df�SCR�IP ION OF WAR
ev s f!:% S 7_61,-1 L-r Ve_ fay 41c- !a U w, See-
heck
ee ec a tat appy:
_Mechanical _Gas-rank `: Gas Piping _Shutters `Windows/Doors
_Electric _Plumbing —Sprinklers _Generator ' Roof Pitch,
Total Sq. Ft of Construction: ' Sq. Ft.of First Floor:
Cost of Construction: $ aDy Utilities: _Sewer _Septic Building Height:
OWN O I S5SN E: C®,MIRA@ 1
Name 1'r0.) - b,1 er�'C�' Name:,1Ol(!o A
Address:J/arrCt Company:sT' I-yc,'e
City:�q- P"e/'ce State:/01• Address: 1PA3 649S/ry ��•r
Zip Code: 3 c/Y S~ Fax: City: F,� State: •
Phone No.2,-?*- 3aLr- off/ w 6310 Zip Code: 3 al Fax: 2 yk k-*-
E-Mail: Phone No ` 2ol- y10 2- 3,9120 _
Fill in fee simple Title Holder on next page(if different E-Mail s�/�JC�'e-gr�r� het/ Sod►- n
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NSTRi TI®N LIEN LAW fNFQRMATIQN:
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: _ of 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
commencingDwork or recording our Notice of Commencement.
C '�
Si ature of Owner/Lessee/Contractor as Agent for Owner Si--'-'L'ure of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
I
COUNTY OF COUNTY OF L c. I
The for oing instr ent was acknowledge before me The r oing instru ent was acknowledged before me
this day of 20 by this day of 20a by
h �
G�
(Name of pe on acknowledging) (Name of pe son acknowledging)
au 44
(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 tion Type of Identi ' do
Produced ..� -- - Produced �,
"Yo°
KAREN S. NIELSEN - <AR"int S. NIELSEN
6M
,' Com( ,n 9 FF 115637 Commission No. � �S IFj, i
Commission No. _ SLI). _
My,C omm ssion Expires �Jr'L +_ Sion ,f FF 11563
My Commission Expires
June 1,2, 2018 p
e Juno 12
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW. REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/203.4