HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Jo - 2 �� 7 Permit Number: s-4
RECEIVE®
Building Permit Application OCT 2 5 2817
Planning and Development Services ' ; �—inTING
Building and Code Regulation Division2300 Virginia Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: 3/ Spm'^/� I-ALC 'f LIZ
Legal Description:
Property Tax ID#: / �� Sd 3" �0,06— Lot No. 36"d
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
a yzL 1 ads i — s �2
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check 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: $ `y ZS G U Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name lZ �eC A N Name:
Address: /3 P Company: M", 'i,-
City: State:, Address:
Zip Code: 3z9C J Fax: City: V,?--v Te.<c, Stater
Phone No.77Z �S'9 - �g 1 Zip Code: 3 z 9 t O Fax.
E-Mail: 166eL� _ (i<k�• Gori Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) tate or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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
commencing work or recording our Notice of Commencement.
I �
Signature of Owner/Lessee/Contractor a nt for O Signature o c or/License Holder
STATE OF FLORIDA`4. STATE OF FLORIDA
COUNTY OF Li. = COUNTY OF
The for oing instrumvirit as acknowledged efore me The for oing instru nt as acknowledged before me
this day of 1204:t by this l day of 20M by
(Name of person acknowledging) (Name of person acknowledging
(Signature of Notary u lic-State of Florida ) / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification P1
Type of Identific Type of IdentificatiLon
Produced ,,, Produced
,,,�..•�,,,,,, REN S. NIELSEN
°= V11 ID b—
Commission # FF 115637 """ KA N NIELSEN
Commission No. = " Commission No. -'��''r
My(6904nission Expires �: Com e n#FF 115637
-%;;,o��;,;:•`� Jun® 12, 2018 '; My Commission Expires
!oJune 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014