HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO(�MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J� ''�
Date: 3 Permit Number: V �1
RECEIVED
Building Permit Application JUN 15 2018
Planning and Development Services ST. Lucie County, permitting
Building and Code Regulation Division
2300 Virginia Avenue,Port Pierce Ft 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 -S14u4e('
Address: S'30 0 blicla.,-V
Legal Description: ji Afjver • .►
Property Tax ID#: 3 d 2• d Sb''" �f�D " Lot No.�
Site Plan Name: Block No.
Project Name: .a/on am_
Setbacks Front 'lo Back: )0 Right Side: 10 Left Side: $0
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Add
itiona wor to bene orme under tispermit-c ec„ a appy:
HVAC M'Gas.Tank' MGas Piping Shutters 'Windows/Doors.
Electric 0 PlumbingSprinklers _Generator Q Roof
Total Sq. Ft of Construction: S. . Ft.of First Floor:
Cost of Construction:$ s� � Utilities: _Sewer Septic Building Height: oZ O
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Name Gu✓ �. O G!�"? Name' s.,
✓ Company: co-
-City: ie vd'Ct - State: Address: &Wc, L c is
Zi `Cade: Fax: jillA Cit %`7°>' �GiG State:
Phone No. o �� Zip Code: J" Fax:7,'*2-yere-.6gd.r
E-Mail: d Phone No. 7 ZZ!AMA A116'
Fill in fee simple Title Holder on next page(if different E-Mail: To`», S rG Q,Y1R4av.Go w►
from the Owner listed above) State or County License:,4ce-1,3 llVd-go.9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 represeritatibn that is granting a permit will authorize the,permit holder-to_build the subject structure
which is in conflict with any applicable Hoine-Owners Associatiori rule's,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,Ido hereby agree that'l 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.eoncurreocyrevlew: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;poste`d,:on the jobsite
before the first inspection..If you intend to obtain financing, consult with lender'or an attorney before
commencing wort-or recording V6ur Notice of Commencement..
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S
_ gnature of Owner Lessee/Agent; lgnature of,665iractor/.License Floider
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
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The for ing instru ent w
, as acknowledged efore me The forgoing instru ent was acknowledged before me
this day of 20 L'd-by this day of�l►j 20 4 by
I � lilc,
(Name of person acknowledging) (Name of person acknow(eccrging)
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(Signature of Notary P/ublic-State of Florida) {Signature of otaryPublic-'State of Florida)
Personally Known ✓ OR Produced Identification r Personally Known V/ R Produced Identification
Type of identifi Type of identification ro q
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K/ EN S. NIELSEN =_ =St �iE.N`S, N7�2�
Commission No E: �iState of r lorid ry Public Commission No. =• •t.° °f F N
v; fission 807484 ' p\oe �omrnis ton' '
\4 i`/ty COmn1ls9l6i� ,X lf6S / OF Fb°\ M CO G
p,+���i1\\ Y mmissio.n
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Revised 07/15/2014
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