HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l� f _
Date:l � ' � l Permit Number: 1
RECEIVED
OCT Z 3-2617
Building Permit Application pER;A177I G
Planning and Development Services St. Lucie ecunty. Fl..
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR:
PRQPOSED INPROVEMENT"LOCATI0N:
Address: z� Gy e� S
Legal Description:
Property Tax ID#: a s,0 l ' al 1 ' V 0 2F�- A00' D 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA[LED DESCRIPTION OF WORK
,C-Al o
Maw PO 0 n
CpNSTRUCTION,INFORIVIATION
1
Additionalworkto a performed- under this permit–check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof ;3 J a Pitch
Total Sq. Ft of Construction: c2-0 Sq. Ft. of First Floor:
Cost of Construction: $ 0 D d Utilities: —Sewer —Septic Building Height:
OWNER%LESStlEE CONTRACTOR:
Name a IV Name.�, T1 AI
.00
Address: �.�t'or,D Company
City: f State:= Add.re ``
Zip Code: .3`0Y� Fax: City.. Stat
Phone No. 777 Wt- od Zip-Code: Fa
E-Mail: Vpg Al"J a &90 e_e,m Phone N
Fill in fee simple Title Holder on next page(if different E-Mail lob L r 7�
from the Owner listed above) State or Count icense
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL. NSTRUCTtON.LIEN LAW 1NFQ"RIVIATION:
>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 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 work or reco our Notice of Commencement.
Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF l (���-. COUNTY OF
The f r13Y
ing instr int Is acknowledged efore me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of lorida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ideqtification Type of Identification
Produced Produced
N S. NIELSEN
Commission No. ComesW1miFF 115637
My Co ion Expires Commission No. (Seal)
June 12, 2018 �!
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014