HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 '��• Permit Number: l� ' l I !5L5
RECEIVED•
Building Permit Application OCT 2 3 2017
Planning and Development Services PERIAITT1
Building and Code Regulation Division St. Lu ' C nty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ' W
PROPOSED IMPROVEMENT LOCATION:
Address: q It °1 n e-ff � ,o S �P,-;,� y d
Legal Description: _ Ot 5 LA A 1'1 CAI I 5 S 164 t\A 'S Lo C7+w i o n
Property Tax ID#: 02-So l 1 3(Q- 0 Uy ' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front. Back: _Right Side: Left Side:0
[DETAILED DESCRIPTION OF WORK:
�i'/ 1✓�w�� Y 7�f`ply �� ���ern,105A
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC Ll Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing U Sprinklers Generator F] Roof Roof pitch
Total Sq. Ft of Construction: lc/� 120 Sq- Ft.of First Floor:
Cost of Construction: $ 00 Utilities: Sewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name La U I- Q rY. (` h Name: Mc4a k La-, h ESI
Address: I c( :1 Company: 0, e h
City: `�p r. ►• ea L State: 1=L Address: IS(a f-�,;� ly1Q U e
Zip Code:3 I S Fax: City:J E h S e I1 ✓`'C<C h State:_E _
Phone No. �Z �z7 0 6,36 Zip Code: 3LI 9 s -1 Fax: -1 1 . 3-1 � �-
E-Mail: Phone No. -1 l a Z2 O 1 LIC1 4-15
Fill in fee simple Title Holder on next page(if different E-Mail: ( I►-- o ( rNN1 !7
from the Owner listed above) State or County License:
13
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
� ► 3o d�3
SUPPLEMENTAL CONSTRUCTION LIEN 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
comm ncin ork o recording our Notice of Commencement.
Al
/iggna—tu o Ow er Lessee ntractor as Agent for Owner Si nature of Contractor/Li se Holder
STATE OF FLORIDA/ STATE OF FLORIDA
COUNTY OF ` .U,)ca . COUNTY OF "4- L' Ir,f� ,
The for mg instru t as acknowledged before me The for oing instru nt as acknowledged before me
this�day of � 20,1 by this day of 20J7 by
)M.Airy " MRu 114 �,t4,
Name of person making statement Name of-person making sta ement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifica ion
Produced Produced
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Commission No. KAREN ELSEN Commission No.
RAN S. NIELSEN
Commission x FF 115637 Commission p FF 1156311
.,
M Commission Expires
My Commission Expires y p
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE M12, 2018
ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17