HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Irl Permit Number: C) r lQ
e Building Permit Application SEP 0�1 .2017
Planning and Development Services PERMITTING
Building and Code Regulation Division Si. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:1772)462-1553 Fax:(772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
.a..r....az, kr x; t a`v�'''. 5AP xw.<:"..'*s.., t,F ,�,..u.'c` 7
Address: 10--*r 2 S C' :SS 41 f-A W& j ?Q ff S'AIMT C00"e
-Legal Description: 90 i..)i 1 302
Property Tax ID#: : 3 -1 j 1�' - ��0 SDS - 1 b Q�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
S
.r s: �, � .,Fz.._ .ate—$`sa.�r _a,kz:f..>'^�r:� 6_n� - .� '��c>• -G�'�"±��-d:4, _
- K* e-i-4� UA-0k - 0.+3 i- f 12-9?off S P(� &I-Airio
}}
WORM
ro `Y
• ^�t+�� #'r,T�._,_, � n 'zstz..� '�'' �s�¢''",� k�(t7�/:'Q`�4 ".� �����`��y����
xVFSEe R-� � 3�
Additional work to be pertormed under this permit-check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator =Roof Pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
CostofConstruction:-$ 02�, 6_% Utilities: _Sewer _Septic Building Height:
01"
- 01
*a; x'S 'Mr'- S"` 'i¢£A ""•,. "H' } ;s'4
� �` y 3 a a mss`
11
Name M 2A 6-t E> Name: •i C-AiJUSCA A-- P&.2
Address:�'��-(�h-:4 M tt i f1 S"T• Company: e4,S CZ 412
City: i,)HA2 State:.. Address: ___.�3-�f_. __�,Ai� 2OL
Zip Code: 1 42-_ Fax`. City: State:ri,'
Phone'No. Zip Code: S3Y (2 fax:
E-Mail: Phone No STS 1 - 3 -'A (13 b D
Fill in fee simple Title Holder on next page(.if different
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
'§,a' .,�,fi - �k +ems v .fah ,*a 6 t
ell :_ ' 100 ,,. CST µ .$
a.« '" .�.. '. �° .�. &
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 thatmay 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 anothe''r 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 firs pection. If you intend to obtain financing, consult-with lender or an attorney before
commenci or or recording our Notice of Commencemen '.
.Signature of r ssee/Contractor as Agent for Owner S=�of .,ontr/Lice se Holder
STATE FLORIDA S1
COUNTY OF I COUNTY OF
The forgoing instru ent w s acknowledge{before me The forgoing instr ment w s acknowledgegbefore me
this�day of 20=1 by this—I—day of 20 '( by
SC6 bf3%4\ -
(Name of person acknowledging) (Name of person acknowledging)A AA
.
(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 Identification Type of Identi iqgdon
Produced L. DProduced L• �•�-':
N S. NIELSEN
01 r ,
Commission No. .. ommission No.r 5 a� �( FN,S. NIELSEN
' �sion# FF 115637 - ommission# FF 11563
My Commission Expires
""%'�o o•',`� My Commission Expires .
REVIEWS FRONT 'ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED `
DATE.
COMPLETED
iev.7/2014