HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: LIQ, Permit Number: 1�4$'da3a.
REUrIVED
EM
ow Building Permit Applic tionAUQ 12 � '9
Planning and Development Services ST. Lud@ Gpprity, 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: Oem 0 ;.0 J,
PROPOS ED'.fN°PROVEMENT,1OCATION
:
Address:
Legal Description: VChlv--f A.ye' ' lot 830
Property Tax ID#: y5-11- 5-JO - 003 - 0®0 3 Lot No. Y30
Site Plan Name: �e''� �� Block No.
Project Name: K?to
Setbacks Front "i�Back: Right Side: Left Side:.,
DETAIl:ED DECRIPTION.OF WORK:
1 1
It(•e e Ablym ,-crn O YQ 0 72W S j A hQ1R{
61
o4 J^A�YYI
CONSTRUCTION INFORMATION
. ,
Additional work p
. e�a� .�. ,..
to a er orme, under this permit—check all that h 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: 7,2 0
se.o a r
Cost of Construction: $ _7�� Utilities: Sewer _Septic Building Height:
C}Vt%NERjLESSEE, s COIVTRACTQR `
_ w . R .
�
Name'' CV.�� �`lq D Name:..i am '✓ .
Address: � 1 �� J+C. 44 G7� Compafny:� 4r» jw'� 1�fi —& eql .7LC /.1c.
State: • Address: d� L� ,`&C V-
Zip Code: Fax: City: 'SBhS�h "I� G�' y State: tL-
Phone No. 50Y - Yq,6- JIBS/ Zip Code: 3Y9'97 Fax:772 232PF/
E-Mail: Phone No 77)- 2X0 -3715-
Fill in fee simple Title Holder on next page(if different E-Mail G��t ,S�! /i `�G o •
from the Owner listed above) State or County License Cdz lZ /98/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLEMENTAI CQNSTRUCTI4N LIEN,LAIN IN:FOR11/IATION
_ • �u MORTGAGE COMPANY: _ � x l
DESIGNER/ENGINEER: _Not Applicable _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 tfie 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
WARNINGTO 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 work or r cordin your-Notice of Commencement.
Signature of Owner/Lessee/Contractor,as Agent for Owner . Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF \-LU.0,-1E COUNTY OF
The f going instr ment was acknowledge before me The rgoing instru ent was acknowledge before me
this day of 20 by this day of 20JJ by
(Name of person acknowledging (Name of person acknowledging)
I
A AJ
(Signature of Notary Public-State of Florida) / (Signature of Notary Pub ic-State of Florida) /
Personally Known OR Produced Identification ✓ Personally Known c4l9entification ✓
Type of Identification Type of Identificatirau-
` KAREN S. NIELSEN
Produced ' �
Produced FF-- ""Y "e�
{•— r �'=Sta a of,Florida-Notary Public
KAREN S. NIELSEN =' •_ Commission #GG 207484
State of Flo��da otary Public P, M ry
Commission No. =_ °' G 207a8a Commission No. ''.,OFF°•- Y(SyauT� fission Expires
- - mmissiW#16. ��' ` Ju1i '12, 2022
9,EOF"oP My Commission Expires
June 12, 2022
REVIEWS. r FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE; MANGROVE
COUNTER REVIEW ' ' REVIEW REVIEW REVIEW` REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 7/2014