HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: Permit Number:-1( --�
RECEIVED
Building Permit Application JUL 0 3 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: To Select from dropbox, click arrow at the end of line qeWR
PROPOSED IMPROVEMENT LOCATION:
Address: 3 (?/-? SIP- .2 PX Zli2ZZ0242 -4 A/e
Legal Description:
Property Tax ID#: 3"S '70 5 O 00 O 3 Lot No.�
Site Plan Name: Block No. 2
Project Name:
Setbacks Fronts Back: Right Side: 3.2-5 Left Side:
DETAILED DESCRIPTION OF WORK:,
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CONSTRUCTION INFORMATION: . .
Additional work toe performed un er t is permit-check all appy:
HVAC EGas Tank aGas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 4,o o o Utilities:n Sewer 0Septic Building Height:
,OWNER/LESSEE: CONTRACTOR:
NameZ2Uycl1'1LCA Name:.{) -, SP
Address: sl,r e_-,VY WOXZo 4) Company: j'),-c o 2 A > ve G o ^/cg47t. SPc.
City: _'yo/2 5w..c-r Z/.'Gi e- State: Address:l6_ -SZ 5 kJ SC �/e-j'C 4 e/L /,to X
Zip Code: _5'19 ,5a Fax: City: P Lu <_;e- State: 4= .
Phone No. 772 8 33 Zip Code:_3 r rPG/ Fax:
E-Mail: Phone No. 17_�2 - X02 �_.✓��0 9
Fill in fee simple Title Holder on next page(if different E-Mail: So 9 1 RQi 7)'!,IA /& 7--m 4 iL zv1'
from the Owner listed above) State or County License: /�/-1,- G,8 C, 12 60 973
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION:
DESIGNER/ENGINEER: x—Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Ad d ress:t 179 NETTLES BLVD,JENSEN BEACH,FL 34957 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
corn, mencin g work or recording our Notice of Commencement.
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1171>An I
Sig ure of Owner/Lessee/Contractor as Agent for Owner SiMature of Contractor/License Holder
STATE OF FLORIDAL '` 1 � �� STATE OF FLORIDA
COUNTY OF �C {� , COUNTY OF
The for oing instr ment was acknowledge before me The for oing instr ment was acknowledge before me
this�day of 20� by this day of 20Z by
IRsseuY- \00 I—evIacceur
Name of person making statement / Name of person making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifi ation Type of Identificatio
Produced_ _, Produced
aAl
(Signature of Notary Public- t (Signature of Notary P 'c-State of Florida)
, KA1 N �S NIELSEN T!� T!!!�!!!I
"n'r"d'% KAREQ� )'
Commission No. °° State of �i)da Notary Public Commission No. _�o�" °a� 1 del NIELSEN
•= Commission # GG 207484 tate of F orida-Notary Public
a My Commission Expires P` Commission #GG 2
OFF`O`�` June 12, 2022 rAy Co�r1m(s5(on ExO1�484
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DATE
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Rev.8/2/17