HomeMy WebLinkAboutnelson w permitPlanning 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
PERMITTYPE: 'me
PROPOSED INPROrVE/MENT LOCATION:
Address: l Au no nn h ► jyic,
Property Tax ID #: . pp Lot No. () `� / J
Site Plan Name: L U Block No.
Project Name: I ff l ,]
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION;
Additional work to be performed under this permit —check all that apply:
`Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
Electric _ Plumbing Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: � f Cd c Sq. Ft. of First Floor: I0
Cost of Construction: $c Utilities: _Sewer _Septic Building Height;
OWNERf LESSEE;.
CONTRACTOR:
Name so
Address:
Name: L
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Company:
s v s
City: \ v c_'�State:
Zip Code: � Fax:
Phone No.
Address:
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City:
Zip Code:
Phone No —1-7
Y State:
Fax: --
2. q C,
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If , ..1. ..F .• ..t... _.: I_ F�rnn
E-Mail ) (,
State or County License
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If value of HVAC is $7,500 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
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:,
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 anyapplicable 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
commencirta work or recordina vour Notice of Commencement.
esee/ on "ctor as Agent for Owner
Sig t Owner��/Ve's
Signature of Contractor/License Bolder
STATE OF FLORI
STATE OF FLORIDAj
COUNTY OF 2'Llucicl
COUNTY OF
The for ing instr ent w s acknowledg fore me
this day of t 20 y
The f oing instru ent was acknowledg efore me
this day of 20 )by
�• 11
meat.
Name o(person mak��OR
Name of person making at ent.
Personal) Known ProducedIdentification
yy
Personal) Known OR Produced Identification
Type f identification
Type of Identification
Prod ced
Produce
S
_
(Signature o Notary Public- State12 Ft i Ada) KA T i If -RI E HAVENS
Ally COMMISSION
(Signa e a o ary Public- State pp 5lgrida)
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#GG16503
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Commission No. _ (.$eal
tiro=, jC, tl �IRES: DEC 04, 2021
Commission NO. „•„•• on e tthrough
1st State Insuran(
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/26/1g