HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,2--7—M Permit Number:7 5
L-4 U0_1-41 11
Building Permit Application DEC 0 ? Lvi?
Planning and Development Services PER"AITTiNG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential (/
PERMIT APPLICATION FOR: 4z l 0—
PROPOSED
PROPOSED INPROVEMENT LOCATION: p
Address: ZSZ• MaQtg ).Q -----
Legal Description:
Property Tax ID#: 3y�� '1- � " LlZcl�7_ f '�Q'-S Lot No.
Site Plan Name: ( CGL\ �S hV�c =0 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 6k:
� �s s
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 V_Roofjt
Total Sq. Ft of Construction: �q�� Sq. Ft. of First Floor: 1"
1
Cost of Construction: $ 660 t'00 Utilities: A Sewer _Septic Building Height: I
OWNERAESSEE: CONTRACTOR:
Name \� Name:
Address: Z�Z 11�_ Company: r
City:_� E' o�G� State: Address: �D
Zip Code:3�C(cQjz� Fax: " City: State:
Phone No. 77 Z -` — 41 q!— Zip Code:_� Fax Z`' �`-a� -�Z Nil
E-Mail: }A- Phone No 2 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 INFORMATION:
DESIGNER/ENGINEER: Se60t 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.
Sig re of Owner/Lessee/Agent Signatur Contractor/License Holder
STATE OF FLORIDA L _ STATE OF FLORIDA
COUNTY OF \, ���r',l� COUNTY OF
The fgjgoing instr4ment was acknowledge-d before me The f r oing instr ent was acknowledg 4efore me
this�day of 20� by this day of_ f�'1 20� by
��y� s,� r���
(Name of e r s o n acknowledging) (Name of perso acknowledgin6 AA =I�L AA_
g)
S
(Sign ture of Notary Public-State of Florida ) / (Signature of Notary Public-St e f F orida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifica ' I Type of Identificatio
Produced L L Produced If L
(�gI�N S. NIELSEN Is�•'� �',`. � N S. NIELSEN
Commission No. I ommission No. _
Commission # FF 11563! - C m' cion # FF
., My Com t 15 6 3 7
3 �P My Commission Expires �'sEo, .o�.` mission Expire
18 s
REVIEWS FRONT UNT ERVISOR PLANS VEGETATION SEA TURTLE MA
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. -1/2014