HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "1 ► Permit Number: a9z
RECEIVED
Building Permit Application SEP 13 217
Planning and Development Services PERMITTING
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:
PR0_POSED' N ,ROVEMtiNT LOCATION
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Address: G
Legal Description: L fir.✓ ��1 ria,-�c/ ,`s�.�.�- ro h
�o�-H FZrs-, f a h-o 04 S ee"A"', s r'/'6,q 2
Property Tax ID#: 3 S 3 57 - 7G i G 0 C; C) G 0 p Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF Wb K
CONSTRUCTIC+N, IV'EORIVIATION m
itiona work toj e pertormed under er t is permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total'Sq.:Ft of Constructi61: Sq. Ft. of.First Floor:
Cost of Construction:$ 600' Utilities: —Sewer _Septic Building Height:
a:
OWNER, LESCONTRACTORr
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Name•��• Name. �� �f-��'+
Address: yb.G ,S. 'C►:.C.� 4� 1 (J
_ �, CoCmpany:- ,.:::,.:.y
City . {:Js z!� State:�4 Address: la C_t/L-ers e1%1_1�'
Zip Code: 3 Y 55' -7 Fax: City: State: L
Phone No. Zip Code: _'3`� `�ci c� Fax:
E-Mail: Phone No 9 z2 -/__ U
Fill in fee simple Title Holder on next page(if different E-Mail<'677,1!-!,z~/
from the Owner listed above) State or County License
hC_ 1 J77 7 �
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCt?NSTRUCT[ON LIEN LAW°INFt�RMAT10
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:'. fl'_3 Address:
City: State: City: State:
Zip:, Phone Zip: Phone:
FEE SIMPL&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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wo ding your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner SignWe of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ( f,C- COUNTY OF
The for oing instru nt wap acknowledge.d�b fore me The f r ing instrum �Aotas cknowledged es me
this day of 26� by this day of 201:7 by
(Name of person ackn edgi (Name of perso nowledging)
rllfgnature of Notary Public-State of,Flori ) (Sign a Notary Public-'state of Floid )
r
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of.lden ' ' ion Type of Identifi ion
Produced ' roduced
"�"' AREN S. NIELSEN N S. NIELSEN
Commission # FF 115637 '�,' °4
*z 3� A Commi Sion FF b15637
Commission No. ,r�;s ms(RFI)nmission Expires ommission No. My Co Oon Expires
•������.��•` June.12, 2018 June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER .REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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