HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 e c S , C I Permit Number:
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Building Permit Application DEC 0 5 7017
Planning and Development Services PER,.411'TI;qG
Building and Code Regulation Division St. Lucie CcLnty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line '
PROPOSED IMPROVEMENT LOCATION:
Address: 5 �L ��twt yv,v r,
Legal Description: es L ►C 3 L�fi fl
Property Tax ID#: .���— 7 0 0 0 0 3 3 - 0 6 J — 3 Lot No.
Site Plan Name: e f" /'6_ rj Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Xe
SNA p dayV"P,,,f- FL_ 160 `/ 8" ,� y
s h ,Nsi�s r� L / 0 �, 7 y -�eiZ
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a app y:
HVAC F] Gas Tank F]Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: ' 02 DOc - S . Ft.of First Floor:
C6st of Construction:$ DDD Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name S h e Name:w l/r L- -/V -
Address: 5 4 Company: V ((el ri ('1
i4 r✓i•� S'fi'�C=fi� �
City: er - State: Address: 5.7-9 X
Zip Code: 3 4'5 :E I Fax: City: r C', --/ L_( State:
Phone No. Zip Code: 3 Y ci Fax:
E-Mail: Phone No. 7 -) %,P &6 ,5-!l
Fill in fee simple Title Holder on next page(if different E-Mail: ►''e'-t �'! �� 's_3 0� O i .C
from the Owner listed above) State or County License: C CC- YD
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:
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
commVong work or record in your Notice of Commencement.
s
Signatu of Owner/Lessee/Contra for as Agent for Owner Signatu of Contractor/License Holder
STATE OF FLORID L STATE OF FLORIDA
COUNTY OF - I �-�C[ 'L COUNTY OF S-/- Lett C -0
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this '5 day of 20 L2by this 5 day of 4 j c 20 L_?_by
An M4n(y ' pa
ej;'NM_go�A.11)
ame dt person acknowledging) (Na a of erson ackn ledging)
(Signa ure of Notary Public-State of Florida) (Signature of Not Public-State of Florida)
Personally Known OR ProdIdentification L/ Personally Known OR Produced Identification
uce
Type of Identification Produced L Type of Identification ProducedL. O/_
pNIELSEN
��c�rr Immission No.
Commission No. - CoEN S.
r�ifiission # FF 11563K,,
My Commission Expires Cm
REN S. NIELSEN
o ._ oMission # FF
june 12, 201-8-- -,�Ep o;oFmyommission Expires
Revised 07/15/2014 June 12, 2 o 18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS