HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I
R ECE 6Vrc,
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Building Permit Application NOV062017
PERM117ING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential c/
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: A- 9 L au L LtQ 61L, e
Legal Description: e±R(aGc, G 4Aa5d Jocu.-
Property Tax ID#: Lot No.7-
Site Plan Name: Block No. Z Z
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Tli Ke Jown1 14x7 6QrQ6,e eloc r a,-e) ,reiela c:,- wi l-In
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_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: $ /3orJ ur) Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1J)e,f;QN &te,.k/cy Name: Tis,4G /�r' ti
Address: M ,�T., � Giv Company: A-7«tti Cu,-cc;c, coo/s
City: iAs,,i Sc,A.J Loci< State: _ Address: 1$G y- ouu,-lion(. /1' cede /3yd
Zip Code: 5Vo5-z_ Fax: City: PSC.- State:__.�-c
Phone No. 72z . US'- if 9U Zip Code: 3 y4i 3 Fax:
E-Mail: Phone No 77 L -&2,5 S(/L
Fill in fee simple Title Holder on next page ( if different E-Mail A 4,-cl, e Qoo/' a
from the Owner listed above) State 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF cS �(�. COUNTY OFA. f!1�(�i�f
The forgoing instrume t was acknowledged efore me The forgoing instrufffrit was acknowledged before me
this day of 20 by this day ofa 20V by
CAASSuut aK
(Name of person acknowledging) (Name of person acknowledging)
c�—�
(Signature of Notary Pu lic-State of Florida) (Signature of No ary Public-State o F oridat 0 AA LLL ) /
Personally Known OR Produced Identification IV/ Personally Known OR Produced Identification ✓
Type of Identifica ion Type of Identifi ion
Produced Produced
�,. KAREN S. NIF
KA � �S. NIELSEN "'' on# F`
'�`""`•%''-, Commission No. • ,; Cor�i��i
Commission No. ,`'° Com iss on M FF 115637 My commissi',
' a r My Commission Expires r „a� June 12.
m
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE """ KAREN S. NIELSEN
RECEIVED
Commission k FF 115637
DATE yCo mss ion Expires
COMPLETED - «� Juie 12, 2018
Rev.