HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED nntr
Date: r)" Permit` Permit Number: rl I I
Building Permit Application DEC 01 2017
Planning and Development Services PE(i''i,ITT i ,1G
Building and Code Regulation Division St. Lucie Count;, F'.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: LOUD C7 �''� `L' i ►'� rC 3
Legal Description:
Property Tax ID#:� InI• oLot No. �
Site Plan Name: Block No. I3
Project Name:
Setbacks Front Back: Right Side: Left Side:
CJI✓�C 1cJ e, di�CL EY_ koLLC_E ZJ LY✓t/ 0041
Additional work to be pertormea under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: /G- Sq. Ft. of First Floor:
��yy D
Cost of Construction: $ 27�� Utilities: —Sewer —Septic Building Height:
Name A fct,4b 5 Name:
Address: 9?2-2 /oneS0rKe Company: wla �l"'r �►5 s r�
City: V% Pie('C�c State:(_- i Address: /")/75-
Zip
SZip Code: Fax: City: rT Pierc-1- _State:
Phone No. 95-1-1 6-1y y37 1� Zip Code: 3y�/'�`L Fax:77 237
E-Mail: Phone No 772 SI C
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.
IL
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
commencinR work op 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 • Liru c COUNTY OF
The forgoing inst ent was acknowledged before me The forgoing instr was acknowledged before me
this__L day of 20� by this_1_day of ment 201T by
—MA�-k keci S Mi%4� Ll mberis
(Name of pe son acknow edging) (Name of person hcknowledging)
(Signature of Notary Public-State of Florida) / (Signature of Notary Public-Sate bf Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifi ation Type of Identifi n
ProducedKARtN S. NIELSEN Produced '
. .p ,U�C' ,,\111.....
Commission k FF 115637 :.o.�"�s;!.� KAR(N �` NIELSEN
Commission No. ' " My co ��ion Expires Commission No. , comm Seary M FF 115637
June 12, 2018 s My Commission Expires
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
IL