HomeMy WebLinkAboutBuilding Permit Application AIIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V
RECEIVED
SEP 2 9 2017
I» Building Permit Application PERMInING
Planning and Development Services St. Lucie County, FL
Biuilding-and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR:
', PROPOSED INPROVEMENT 1�O.CATIC?N:
Address: 7 70 3 ��—
i
Legal Description: ma.owls
Property Tax ID#: Lot No.
Site Plan Name: C� Block No.
Prioject Name:
Setbacks Front Back: Right Side: Left Side:
'I DET LLED D �S�R)PTION OF WORK:,:..... .
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&Ir wLs 'r L'a r, 12— 6�t 1;�cr&—'r , 0 t, ke-
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CONSTR+UCTIO I+N FORMATION:
Additional work to be pertormed 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: �e 7 Sq. Ft.of First Floor:
Cost of Construction:$ bd Utilities: —Sewer _Septic Building Height:
O��R/LExS`�S�E: - CONTRA OR:
Name' Name:
Address: 7703 �� �ae PP►4.,ti Company: jt✓ Gfe.`>�Z I'�uS LLB
City: State:1"L Address:_,.:�/0�1(:.,:SJ, W9*cG'
Zip Code: 9Y Fax: City: k ef �14 State:FL
;Phone No.792 io`f 3- !>2 �l l Zip Code: f S Fax:
!E-Mail: 444- Phone No 7 7 2 216 -i 3 V 4
!Fill in fee simple Title Holder on next page( if different E-Mail
;from the Owner listed. above) State or County License _2 g q /Cf
If,value of construction is 2500 or more,a RECORDED Notice of commencement is required.
SUPPLEMENT' L C«C}NSTRjUCTIaN LICE LAIN IINFO'RMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:,_: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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
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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
commencing work oVecc/ding your Notice of Commencement.
Signatur=oLeGseie/Contractor as Agent for Owner Signature%L0tRI rac or/License Holder
STATEA STATE ODA
COUNTY OF COUNTY OF 4. 1�9�1
The 7day
ing instru nt w s acknowledged before me The for ing instru nt w s acknowledge efore me
this of 201 by this day of 20�by
CVD)uo 3ttj , - II
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi on Type of Identif tion /
Produced it Produced lJ
i
1,71 1 1-A A �v ("Acv—
(Sign 6tu a of Notary Public-State of Florida (Signature of Notary P
KAREN S. NIELSEN KAREN S. NIELSEN
Commission �'a
commission 8 F Qe 637 =`° Commiy"I� FF 115637
(� � Commission No. s. ._
_. •= - My Commission Expires
�= My Commission Expires ,�;
June 12, 2018 � 0ti� � June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7