HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: 4 �`• 1� Permit Number: 1 -1
ell-
J.L--fi I RECEIVED
Building Permit Application JAN 1 1 2018
Planning and Development Services ST. Lucie cg4nty, permitting
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:
PROPOSED INPROVEMENT LOCATION:
Address: 1 Vii ) N "v'?;rc,� ��� Aycr
Legal Description: (L,�e Qc:1r-Y� t,��;�T 1-{ y�1-r �� Lei!' C
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
HO vF L{ TO( 914cl�,// C �j1��r.� �rnli ��;iit`' ✓.a" JAA
+ _ -,-Yr e OF i CSG r�` /STC/• I O�h�,�t <,:ft
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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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Ll(2C) Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name l Name:
Address: �i'-i3 N �Jc�rc+1`� AyC Company: r' K
D
City: r S L- State:EL Address: _����� 621,-eC Or .
Zip Code: Fax: City: Ur', Stater`
Phone No. _77X at -:ZSd�4 Zip Code:_54g46 Fax:
E-Mail: Phone No X71- 7 i 7,7 3
Fill in fee simple Title Holder on next page ( if different E-Mail +5 re;c13 c'r )
from the Owner listed above) State or County License 2927
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 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 or or recording our Notice of Commencement.
Signature of Owner/Lsee/Contractor as Agent for Owner Signature of Contractor icense Holder
STATE OF FLORIDA /� ` STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledge before me The for oing instru en was acknowledge before me
this day of 2011 by this day of 20J4 by
.0 6r, Ir
(Name of person acknowled gin ) (Name of person acknowledging)
C_
(Signature of Notary Public-State of Florida ) (Signature of Notary ublic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification Z
Type of Identif' ion Type of Identification
Produced Produced Fir
q9 ;,+;•�"" REN S. NIELSEN
.a I Corr# S S' NIELSEN =•
K E Commssi
Commission No. =� Commission No. Qs �lf 115637
on# FF 115 337 ,��F °Pow. Y Commission Expires
" June 1 2. 201 8
My Commission Expires "'���
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
—_ _-- -
Z of 3(Sketch of Survey)-See Sheet 3 of 3 for Legal Description,Certifications.Property and other Survey related data.SURVEY IS NOT COMPLETE WITHOUT ALL SHEETS
BEARING REFERENCE:
x� NORTH LINE OF N.E.NARANJA AVENUE AS S.71°30'00"W.
ALL BEARINGS SHOWN HEREON REFERENCED THERETO.
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5CALE:1"=40 ER
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AERIAL PHOTOGRAPH
(MAY NOT SHOWLATESTIMPROVEMENTS) t
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00AiSDE RECEIVED
JAN 1 1 2018
Lucie County, Permitting
o A N Applicant has been advised NO structures
\ can be erected within any easement or
right of way unless o se approved.
Applicant Initials: 7'
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NE aC f
2310 �R \A3 n
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6d i `01800 G-
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Platted Easements,Notable or Adverse tonditionsTunplatted easements a so listed'provided by client:
6'UTILITY AND DRAINAGE EASEMENT ALONG WESTERLY AND EASTERLY BOUNDARY LINE OF SUBJECT LOT
•20'UTILITY AND DRAINAGE EASEMENT ALONG NORTHERLY BOUNDARY LINE OF SUBJECT LOT
Tlfis survey has been issued by the following Landlec Surveying office: PLEASENOTE-. ' 4
600 Fairway Drive-Ste. 101
SUBJECTPROPERTYIS SERVICED BYPUBUC UIlUnES.
NO APPROVAL FOR CONSTRUCTION HAS 00N/A ByMOFACE
Deerfield Beach, FL. 33441 kb Number:86196 SE %.: LANDTEC )O
Office: (561)367-3587 Fax: (561)465-3145 Dra.By: J.BAEZ P,. S U R V E Y I N G
www.LandtecSurvey.com ..,,,. 7.. .�..
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Date of t1R92011 Rev.: �+�°�."-uru6/'y b,•nr,:�
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