HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF�O1 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 Permit Number: t l J ti✓
MW
Building Permit Application SEP 0`1.2017
Planning and Development Services PERPAITfING
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:
4 z'C c`� «scup '+;; '�`. r_. '3 "',�..id.§^'pt Y.. �,.." �� �
�. � e £ ..,,>t,� h a. .# r 3ps" a _x�„ '��u..1 c M .t R3
Address: 10--*t 2 S -JS 41 e_ +W A`1 PO 9'LAu�'f L_tdCw 5
LegalDescription: TI id31
Property Tax ID#: 5 Lt Lot No.
Site Plan Name: -Block No.
Project Name: '
Setbacks Front Back: Right Side: . Left Side:
3N
}
_ �`JC(a C�'� �A►'`I G� I�/.y[- �� .C•-.��OIJ -S P�� S`/S�h/I "W i l.�i- ?l t1
q', 3z e: %, a �,*'5.h.F`�' a •` s,,KS' ,-s k.,,� cF,
Ne
M.. ..,a,...,.�z,. w
Additional wor to beperformed un er t is permit-c ec. all that apply:
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:.$ _ Utilities: _Sewer _Septic Building Height:
t'§,i • t yc,:*
- FloQMFOR
Name j�% C'7�0A eis L P. Name: F-j?_AjJ GS W_ A, DA s
Address: to b_:4 M 1t f as S"T•. Company: e4 S CQ A/2
City '--ALO State:. Address:--. CAITA,- 2gx
Zip Code: 1 t-t'o?- _ Fax: City: -I�lT } i State:�i
Phone No. Zip Code: 33 q..) (2 Fax:
E-Mail: Phone No ( - 3l-�k • y 3 -0 D
Fill in fee simple Title Holder on next page(.if different E-Mail �S 'iic. 3oo C�m�>y, f,�r►�
from the Owner listed above) State or County License r A G
If value of construction Is 2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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 firs pection. If you intend to obtain financing, consylt_with lender or an attorney before
commenciMg fyorkor recordigg your Notice of Commencemen!
r
'Signatureof. r ssee/Contractor as Agent for Owner .�5. natur of,Cont or/Lice se Holder
STATE. FLORIDA STT FLORIDA
COUNTY OF I COUNTY OF 1�J
The forgoing instru ent w s acknowledg before me The forgoing instr ment w s acknowledgegbefore me
this day of 20� by this�day of 20 'l by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification
Jype of Identification Type of ldentifiqaWn
Produced,__F L Produced �.• �•�-' .
. ."� N,S. NfELSEN c 'r
Commission No. SIJ . ommission No.r • i 5 a� �( N,S. NIELSEN
C Sion#FF 11 5637 ommission#FF 11563
My Commission Expires
"%y�• M.y Commission Expires
a as 1!7 gni A
ZU18
REVIEWS FRONT `ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev..7/2014