HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a ( � Permit Number: 111' U F:�,s
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F Building Permit Application ®v 2017
Planning and Development Services PEI"ill-TINIG� St. Lucie County, FL
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:
PROPOSED INi?ROVEMENT LOCATION. `
Address: I y P e R C�J �,� Srt • -F+- 9 9 91
Legal Description:
Property Tax ID#: G ' .m Q�' l ) 4 7c? Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks FrontOJIX 12 -S Back: Right Side: �5j Left Side: d VcA,
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DETAILED DESCRIPTION IF WORK
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CONSTRUCTION INFORMATION .t
Additional work to be performed under this permit-check all that app y: ;
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: oZ 46 Sq. Ft.of First Floor:
Cost of Construction:$ to On, Utilities: —Sewer —septic Bluilding Height:
OWNER/LESSEE CONTRACTOR:
Name l k0 C1S SOOf-h 2 d J- q VP— (,GLR Q0ame:
Address: 1 (I V Company.
City: I ,, 2rt-c- State: 1 Address:
Zip Code:31ct Fax: N/PA City: State:
Phone No. ? R 7 IL Zip Code: Fax:
E-Mail: 1'AafkVh0'+v1 42-01 (P C-O YV\ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,-a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCI"IN l:IEN LA11V INEORMATI�PI:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
— — pP
Name: DCW iS Name:
Address• S0 Address:
City: C@. State: 1. City: State:
Zip: : ct Phone cto 1- 53G - D3 6 S 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
commencing work or recording our Notice of Commencement.
Siq#6ture of Owner/Lessee/Contrac or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF IJ�Jc,(F, COUNTY OF
The f going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of �AAV 20a by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
::�,(01�16 A `I. K L-8.
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(Signature of Notary Public-State of Florida ) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification d Personally Known OR Produced Identification
Type of Identifi n Type of Identification
Produced L oduced
KAREN S. NIELSEN
Commission No. ,2 �j59zdb mis i FF 115res mmission No. (Seal)
o= Ydl��}�mmission Expires
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.