HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � 1 Permit Number: O v .
RECEIVE
Building Permit ApplicationSEP 01 2W
Planning•and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St, Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _� Residential
PERMIT APPLICATION FOR:
PROPOSED INROVEMENT�LC�CATION ,
Address: I0 Q_5; �'. ',.)S1 WA--i X021 S6.0- LtIGL FG.
Legal Description: Oki f1-4
Tax ID#: 3 q A 9 - SOA Son Lf_ 16o Lot No.
Site Plan,Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK.,•°�
P eTL14 ULA JJ&K 001 0f ,9_' M iJ S F T S ys i M u)I i 4r- df
C
a
CONSTRUCTION,INFORMATION
Additional work to be per orme un er t is permit-check all that appy:
1,/Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doofs
_Electric _Plumbing —Sprinklers Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
i
. .Cost of Construction:.$ a:4�, (�� Utilities: —Sewer —Septic Building Height:
C4UUNERjLESSEE. CQNTRAGTOR:
..
L
Name �_ Name:...
� � �- ���-(�1,�c -
Address: 'X, ''b'� tVl lel,� S7 Company`:
City: ,1 T:tFALP State: Address: 1.3q ` LAJ� -'�j:'t(I.,- 2�)
Zip Coder 1fo'2� .Fax: ` City: TOS.'-_.:::�' t',G�) State:F14-
Phone No. Zip Code: -a3 4'0) G Fax:
E-Mail: Phone No Sb I - q3 '0 0
Fill in fee simple Title Holder on next page(if different E-Mail Q,43 tQq2/Lg3D0 Q_6 M Pl I. Czn2
from the Owner listed above) State or County License r1A C�__ 1 Ifo
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPLE-tViEIVTAL;CaNSI'RUCTIQN t:IEN 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 firspoinpection. If you intend to obtain financing, consWt_with lender or an attorney before
commenci or, or recordiDg your Notice of Commencemen
Signature of r ssee/Contractor as Agent for Owner Si' nature of,Co�ntr cfor/Lice se Holder
STATE FLORIDA STjFF LORIDA 1
COUNTY OF COUNTY OF 1.�J
The forgoing instru ent w s acknowledg—{before me The forgoing instr ment wacknowledgegbefore me
this day of 20=1 by this�day of s 20 ' I by
(Name of person acknowledging) (Name of person acknowledging)
hA L
(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 Identific on Type of IdentificAti
Produced L. U Produced b' (�• �• ��
N S. NIELSEN c
Commission No. t - Ft� ommission No. r �) "o;�,, .� N S. NIELSEN
c m i sion# FF 115637 -
=' �' My Commission Expires ?• ,; ommission# FF 1 1563
=; o Y Commission Ex
pires
„������ 8
REVIEWS FRONT ;ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014