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Building Permit Application
All APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ Dal 2n8 Permit Number: 1 r� RECEIVED a AUG 21 2098 Building Permit Applicati nr. Lucie county, Permitting Planning and Development Services 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: V W'\O• PR0 'OSED I( PROUEMEINS T L©C TICI Address: �d�3 0, C_A0r J(-. Legal Description: Property Tax ID#: V ` (3 00 ` ® Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DE tAILED DE=S�R+IPTION OF WORK: y✓i 0.1 'Co l'J/Iec� 1'Yr� e1 � �tyy5 �Z_ CO'NSTR ON] • IM,4 ATItJNi, : Additional work to be pertormed un er t i ermit–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:$ 1 , �d Utilities: —Sewer _Septic Building Height: • 0 NER/L�S`�S�E: CDNTRACTC+�R: Vn' avwll e -:Name-- . yee Com►',r Name---° Address: D `� < �- Com 'an p y:,.. ty: � C� -' �` State: FL Address Sl�� 'i -e. �� .Zip:Code:_34 g Fax (',r2SZ - State: Phone No. Zip Code: .3`7 X75 Fax: E-Mail: Phone No V. 3oq, 7 7 Fill in fee simple Title Holder on next page(if`different E-Mail from the Owner listed above) State or County License FC_ 7// 93 t9 7 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CQNST +UCTI®N LIEN LAW INFOR+MATIQN: 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 thepermit 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 comment' work or recording our Notice of Commencement. 410- 4 Signature of Owner/Le see/Contr for as Agent for Owner Signature of Contractor/Li erise Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF La)kC-_. COUNTY OF The fo going instr ment was acknowledge before me The.for oing ins ument was acknowledge before me this day of 20� by this a day of 20JI by (Name of person acknowledging) (Name of person acknowledging) c e.J-- (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification V/ Personally Known OR Produced Identification 1/ Type of Ident fes'cation Type of Identifica ' Produced Produced "yp!"., KAREN S. NIELSEN ;.�;aJP��, A{�EN S. NIELSEN mmission No. _'=°�Pp 4B�:State of(tg@eb�_Notary Public Commission No. .° ��'-:Stgl!-0 Florida-Notary Pub is = Commission #G� Commission # GG 20748 207484 �iFOF FIOPO�`` M Y Com mission Expires My Commission Expires Nne,.12, 2022 REVIEWS FRONT O IPLANS VEGETATION SEA TURTLE M NGRO COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED . ev. 7/2014 I . . . . -11 " , ,, - I I �� :1 '- � , .,- ,., , .- , __�� __� .,�,� - - .'t,,�, : ,,-,, ", -;��,,, i,, �, ,,-,, ' ��,,- ,�',,,-�,'�,,,,I 11., - ,- I �� " A, ,,;_ *.,,--� .�-,� , �;.-,-,t__ i ,1,1� �� .�_T, ,1ZT,_ . �:,_11-7,7"�7- - .� ' 'n_;7�_,_�"� 4.� 'i�r, _".,.r I z _11�,�l " - 11 � �I ,�� j", , ., -�- - ,�, , _1�;,�,',, ,- �, ,,- ,,- ,,_�- � ,,, I -I , ",- , � I q � , I-11 I ,- ;" I,,I,I", �,-t, ", ,,�,���"t",�,,,��_ --, � -� ,-1,",, � -�`,�,w , , ,, � , , . -,� �r , � I,��J, "",,.,,,,I _W,nTttt _,�c"�, , -- ," I,. 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