HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 61 o2l
Building Permit Application AUG 2 5, 29PF
Planning and Development Services
Building and Code Regulation Division PEFY'AITT11NIG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie COUnty, FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line W-101mi
PROPOSED IMPROVEMENT LOCATION:
7q? gr,.we r-L- 3q'?
Address:
Legal Description: P) af-a- o g--
Property Tax ID#: '3 q2-7 -70 0 0 0 00 -2 Lot No.
Site Plan Name: Block No.
Project Name: (?,f M J o-c ,OL 1"t ck 2eelgcae r5 (?— )
Setbacks Front Back: Right Side: Left Side:'
DETAILED DESCRIPTION OF WORK:
A-emov-e- 0,-,J- 0--crIck-4.4- '4-Q r,5 C1,W1 P'l C
1_9 � 101.W ';7
#'r, Le C1 (4- 0-p-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all apply:
E, 0.
HVAC E]Gas Tank as Piping Shutters DWindows/Doors
Electric ElPlumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt of First Floor:
Cost of Construction:$ C2, '-�070-0 Uti I itiesIn Sewer ElSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: �,ku'cv-N -Ik 10 Le—
Address: `1 lt-L- Company: Le- C_
City: 125L, State:r-z._ Address: 1qS_!F< e-;PzAJ W ('v14A'_5
Zip Code: 3110 22 Fax:— City: 1:bilkl C'!A Fl- State: r-L-
Phone No. '7'71- - L/ 114 -V( Zip Code: 39�16 ' — Fax:
E-Mail: Phone No. 7
Fill in fee simple Title Holder on next page if different E-Mail: `1c-'0UL (CLf)-1A"
from the Owner listed above) State or County License: C L 15,1 9(9 �Y
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ) COUNTY OF��
The forgo'ng instru ent was acknowledged before me The for oing instrume t was acknowledged efore me
this day of 20 'ill by this day f l9 20 by
`1 `l
Name of person making statement Name of person making statement V/Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi Type of IdentE" U
o
Produced 1� 1, L Produced
ca—
AA
(Signature of Notary Public-State of Florida 1 L _ �,,. ignature of Not ry Public-State of Florida)
I N S. NIELSEN ��m_
Commission No: pa�j mmissionN1 �� 7
n1 F1ssion# FF 115631 ,•�,,
°k(s .4— '= My Commission Expires `% ��, Commrssron# F es
-19 8 ,v``jn q° MY Commission Expir a
June 12, 201 is:..,,� 201 8
<�s' June 12•
-...
REVIEWS FRONT ZONING SUPERVISOR PLANS V99TTMN SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17