HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: 1' �' 1Permit Number: \ .
• NOV 0 9 2W
Building Permit Application
PERMITTING
Planning and Development Services 5t. Lucie ounty, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT APPLICATION FOR:
Address: –7 6 3
Legal Description:
Property Tax ID #: 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional o e per Orme under t4Ti permit–c4-ec—all–that app>
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric '_ tumbing _Sprinklers _Generator Roof Pitch
71
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
0
Cost of Construction: $ ��--L– Utilities: _Sewer _Septic Building Height:
Name 0 1CCDVIC L Name: .tv„ ver J/� _
Address: 'L Z51 c^ "•G✓' �� – Company: /f ✓� ��1
City: D S L State: Address:
Address:
Zip Code: 1 Yy/C Fax: City: l X State:-r i
Phone No. Zip Code: J'7�d Y Fax:
E-Mail: Phone No Z �7 /-,
Fill in fee simple Title Holder on next page ( if different E-Mail
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 INFORMA=N.W,
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,swim pool ,fen 1,walls,signs,screen rooms and accessory uses to another n residential use
WARNING TO OWN-W:Yo y ail e'to Record a Notice of Commencement may result in, ur ying twice for
improvements to ya r prgpert .,A Notice of Commencement must be recorded a p, ed on the jobsite
before the first in�pectiA I , u intend to obtain financing, consult with lende r r ey before
commencin wo or eco 4tl our Notice of Commencement.
Signature of wner/Lessee/Contractor as Agent for Owner Signature of tractor/License Holder
1. 7
STATE O FLORIDA 1 . ',�� STATE OF FLORIDA
COUNTY OF �.u,y�� COUNTY OF
The f oing insttumen was acknowledged before me The f going instrument was owledged before me
this T day df. 204 by this�day of 20J7 by
41
✓�, 111 616 p 11
(Name of,pe so(yac((rlowled ',ng(, (Name person acknowledgi )
_ II.JI •
(Signature of Nota ublic-State f Florida ) (Signature of Notary Public State of Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Identifica ' n Type of Identificati
Produced Produced
KAREN S. NIELSEN AR N S. NIELSEN
Commission No. '�`'" "`'' l,� A�,�1
Com Utbn a FF 115637 Commission No. ,'�'` oo ssion# FF 11563
S� ♦� f,
= oma My Commission Expires - � - My Commission Expires
June 12, 2018 ''E°„FewJune 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.