HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Z0 t C Permit Number:
r i
�� LL
--� -s Building Permit Application JUL ; I
Planning and Development Services 0ER `Al "M"'1u
Building and Code Regulation Division St. Lucia County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Siding
PROPOSED IMPROVEMENT, LOCdATION:�j y L J j (,(� 2
8ririrece• - U %. ri/ 1-ni (JCkY rn e-, tJvl� 1✓� �Or�' S(J(�'✓�T (��Lj`Q/ ILL' J Y /d 7
Legal Description: _0,-d&y, 2 L'atk, La k LO i61K:f ?7
Property Tax ID #: Z1 01 - 0 OS 5 - 000- 1- Lot No. �0
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION OF WORK:
Left Side:
S i a i n � 0 U-2� 2r ���-► n � 5 g `� I � r �,� F��� � � 1.ti. 5/ g l� l-1
2cvri�tPe., anal 24 `�cit•4. Ar�'ViJS r;o°rk� ght�.h
S,�i�"� owe inS` Il��f J/fo
CONSTRUCTION INFORMATION:
itiona wor c to e e orme under this permit -check all apply:
0HVAC 0 Gas Tank ❑Gas Piping _ Shutters Windows/Doors
11 Electric 1:1 Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: 1 7 — Sq. Ft. of First Floor: _
Cost of Construction: $ 0/ O Utilities: E] Sewer E] Septic
23eyv
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name A 14 t 6M ka bX ,,,
Address: �Z S� 14tdc1.1y,
Name: Ace'.� �btv
Company: %fit¢., a`� ✓IrF G
City: S Z, Stater
Address: 15ijZip
City: S(y" uL State: F�_
Code: Fax:
Phone No. 7 Z'- YC4 - `LI I ?j
Zip Code: 3qG9 b Fax:
Phone No. 7-1 L- q O S_
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail: !�) el13 (e, `L) `,4-+< 11/Z4-
from the Owner listed above)
State or County License: C & G' i 6-1 g&Srf
If value of construction is $2500 or more, a RECORDED Notice of commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE BOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
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 your Notice of Commencement. _
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE.OF FLORIDA
COUNTY OF .14.`��F,
The forgoing instr ment was acknowledged before me
this day of 20I—q—by
(Name of person acknowle ging )
(Signature of Notary Public- State of Florida ) V/
Personally Known OR Prod c d Identification
Type of Identification Produced r L,
Commission No.
Revised 07/15/2014
�f— s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF '4•
The forgoing instrument was acknowledged before me
this 11 dav of 20 q by
� L
(Name o person acknowledging )
(Signature of Notary Pul ic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
KAREN S. NIEL E-M"
Commission # FF 1 1 5637
June 12, 2018
No. F 7 (Seal)
KAREN S. NIELSEN
MY V J i.
My Commission Expires
June 12, 2018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS