HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2� • Permit Number:
L�h e s t i z.
Building Permit Application AUG 2 5
Planning and Development Services
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Building and Code Regulation Division St. Lucie Cei:nijr, FL
2300 Virginia Avenue,Fort Pierce FL 34982 `
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lin
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;PROPOEDIIVIPROUEMVT�
Address: 5305' 5&V b! MM
Legal Description:_ RrTwm dr14r 9 A-DDN bt-k Le TS I A-,y-b 10
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be nertormed under this permit—check 11, appy:
HVAC Gas Tank OGas Piping Shutters �Windows/Doors
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Electric Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: pp SFt.of First Floor:
Cost of Construction:$ G o2�B , Utilities:n Sewer Septic Building Height:
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NERjLESI� COIUTRA fiOR P. R
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Name CIU P2 S 1% Name: el . ,Aj -�/�,
Address: 5 3Q.� Sf�u �IeAy I�Company: e-r- Awp AoR.6- 9-r- rwr �' 0-i
City: 'r4i Ply State: Address: 831 51,��1/If(� 1*
Zip Code: � ig(e Fax: City: li�_�1 G� Stater
Phone No. -1'7)-- LJOR— V73A Zip Code:
E-Mail: Phone No. '7_7A- V91 - L/i5'0 I
Fill in fee simple Title Holder on next page(if different E-Mail: dAqyM j@ 4001',' �6�(nWFe.:�-t'_, CW
from the Owner listed above) State or County License: OUL, Y�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 lender or an attorney before
commencing w.ork or recorAng your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ` STATE OF FLORIDA
COUNTY OF � LU C16 COUNTY OF . L.GIf—
The for oing instr ment was acknowledged before me The for ing instr ent was acknowledged before me
this day of 204 by this day of 201T by
Name of person making statementName of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
V�Q A A
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V----
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
P, AREN S. NIELS_'' ' �"� � oi;''o &60EN S. NIELSEt
Commission No. i __—,,,,,,(Seal C'om ission No. s
Commission FF 11 637 *_ ommission# FF 1156
My Commission Exp res ^,� y=' „ My Commission Expir
yreo'sf j"p` 12,
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June 1 2, 201 8 ��-,,,,,,,,,,� June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17