HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q CIA 1
Date: �' ��' �� Permit Number: \ () �� y
RECEIVED
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Building Permit Applicatiop JAN 19 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: W
PROPOSED IMPROVEMENT LOCATION:
Addres3 W c M_'
Legal Description:
L
3 ;LH -70a
Property Tax ID #: `� Lot No. �s
Site Plan Name: Sc�,,c,�,,,._ (,\vb Block No. (�,3
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ky r-
CONSTRUCTION INFORMATION:
Additional work to be performed undertfilis 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: $ 630 co Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name �4V Name: C�i ccs"
Address:'77olJ� n11�_ it, " ci Company: (,v� `` -
City: Po•l� �r}- (' l.. Stater Address: 510- I N� � -�Gr� e `�
Zip Code: � � Fax: City: 3�- L.,xt-f_' State: �I
Phone No. q o 76r � Zip Code: 3 A G K Fax:-
E-Mail: 1-A-AA- -_3 Mr Phone No .Z- Jq 6 —Od a3
Fill in fee simple Title Holder on next page ( if different E-Mail koxY 5IL(Nr�C; '(` C(g-P C0(n
from the Owner listed above) State or County License LA CO 17 �l
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 O OWNER:Your failure to Record a Notice of Com
incement may result in your paying twice for
beprr th �ts to your property. A Notice of Commenceme must be recorded and posted on the jobsite
o t f r inspection. If you Intend to obtain financing cons It with lender or an attorney before
conn nc n ork or recording our Notice of Commence t.
Sig a 'ur essee/Contractor as Agent for Owner Si ture of Contractor/Lic nse Holder
STATE OF FLORIDA ATE OF FLORIDA
COUNTY OF i rCOUNTY OF
The forgoing instru ent was acknowledges efore me The�Tdayof
ing instru ent was acknowledge before me
this l day of 20� by this 20 10 by
(' A' grCRct ��60 �Z
( ame of person Acknowledging) (Name of person ack owledging_::taUjiA (�
)
�Cr
(Sig ature of No ary Pu lic-State of Florida ) (Signature of Notary Pu lic-State of Florida )
Personally Known OR Produced Identification J/ Personally Known OR Produced Identification v
Type of Identifi tion Type of Identificatio
Produced Produced
.............. !CARE S. NIELSEN I�pRE S. NIELSEN
Commission No. "" � a� ,,��
omm!s FF 1 15637 Commission No. ,� CcWr�94Stion# FF 115637
_ '_
= My commission Exp!res - _
rvty Commission Exp!res
June 12, 2018 '� June 12 2
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014