HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1' 1 Permit Number:
A C E I E D
Building Permit Application NOV Z 9 2017
Planning and Development Services RUAITTING5t. 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
PERMIT APPLICATION FOR: ,/¢C10C
PROPOSED IMPROVEMENT LOCATION: ,�
Address: 6Z63 �-/Sc'eo/ek l'd� u>>` 1 � -c-c 3
Legal Description:
Property Tax ID#: I�> O) (,27- - 00 75- Oy CI Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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: $ /, 6v c)• 60 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name J o,rj (7 te4 Name: i 3V0 rAZC��QZ
Address: x`703 5aeok, Company: (ovL, ^"J,�tC . �o.J rJ(_
City: Fc,,'1- State: L, Address: l'l 2$ ',E Q\lcuV 0
Zip Code: 3�l 7 / Fax: City: O(A ?gv�,.►� l.�ie State:
Phone No. 772-- 5"6) - ( `/ j Zip Code: 3495L Fax:-1'72gt0�- q0 S{
E-Mail: r �e. �47 ► C ov�' Phone No c b -736q
Fill in fee simple Title Holder on next page ( if different E-Mail & -p-, C
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 teed for any restrictions which may apply.
A.,
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.
ZaZ�]Z�- -,-4�4__'7 498��
Signa6w6 of Owne s ontractor as Agent for Owner Signat a of ContCacto- Afce&llolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � LRIE, COUNTY OF
The forgging instrum nt was acknowledged before me The for ing instrument was acknowledged before me
this _ day of 20i4�by this L4Z day of 20_/7by
CyN7181 �Z,7 t I )'I G 1AZ
(Name of pe son acknowledging) (Name of pe son acknowledging)
AAc�---�
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifi ' Type of Identific
Produced L. Produced
KAREN S. NIELSEN
KAREN S. NIELSEN '•°SFT ^'
`fo�•..•� : C,,'', - Commis
Commission No. _ � /ission x FF 115637 mmission No. °� KARE=N
•_ ;; ar My COmmission Expires
My Commission Expires ''%„°;,`„°:`� June 1 2, 201 8
°-,°;,',;,�• June 12 2ni.Q
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.