HomeMy WebLinkAboutBuilding Permit Application All APPUCA�BILE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "1 • 1' 1 1 Permit Number: I
RECEIVED
Building Permit Application SEP 0'1 .2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:1772)462-1553 Fax:(772)462-1578 Commercial_ Residential r
PERMIT APPLICATION FOR:
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Address: y 41 4 W Ami ?0971r SAW!- C.UCY
Legal Description:
Properly Tax ID#: . 3 -1 j - 501- S7 00 q- I bo Lot-No.
Site Plan Name: -Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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Additional work to be pertormed under this permit-check all that appy:
V Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
.—Electric _Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:.$ (135 Utilities: _Sewer _Septic Building Height:
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Name G t'TD(tA 6t, L Name: FI— iJ GS 0 A--- 20wt g
Address: Mtt-1 a ST Company:. eAS C,0 411Z,
City: % I'r A2.O Stater Address:..__ _.�"3.�{____I,AiJW7£l'L i2a -
Zip Code: 1 L-f'o`2s')A Fax: City: `R�J j?IoJ Ec"O f,�i State:Ftf
Phone No. Zip Code: 33 4') 16 Fax:
E-Mail: Phone No S b 1 - 3-1`4 • 43 0-0
Fill in fee simple Title Holder on next page(.if different E-Mail p f S L%-A(n,,!q3oo Q n'Isrly, i.�rh
from the Owner listed above) State or County License CA C_VS-1_(p(bi.
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 commencedprior 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 conflictwith 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 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 natu.-of ont or/Lice se Holder
STATE 06CORIDA ST FLORIDA 1 .
COUNTY OF I COUNTY OF l.�J
The forgoing instrurnent was acknowledge{before me The forgoing instr Ment w s acknowledge efore me
this 171dayof 201 by this_A_day of 20L�by
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(Name of person acknowledging) (Name of person acknowledging)
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(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 fdentific on Type of Identifi n
ProducedL •�.% Produced �.• �• �..
N S. NIELSEN „�.,
'I �
Commission No. �.�, ommission No. � 5 a� �.�,_ .�( N S. NIELSEN
C sion#FF 115637 *_ ommission#FF 1-1563
My commission Expires
= M.Y Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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