HomeMy WebLinkAboutBuilding Permit Applicationi
ICABLE INFO MUST BE COMPLEFOR APPLICATION TO BE ACCEPTED
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1�• ��'� Permit Number:
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Building Permit Application
NOV 0 2017
Planning and Development Services
Building and Code Regulation Division
PAR"fITTi��v
5t. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: 5 I
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Address: 3 1� Lv• 1�i�(C�(�, 3y 0
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Legal Description: 4_1 Q � kt S' r p r rr �$Z
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Property Tax ID #: y o2 6Dga il1'7 2 60(1:9 Lot No. 3�
Site Plan Name: 7 ild i a R;ye f Z S 4-ejg_( Block No. �
Drojer.t Name:
Setbacks Front_ �'3 Back: 4 0_ Right Side: 2v. d 3 Left Side:
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dAdditional work to be perrormed ¢un er t is permit - check all that apply:
2-'Mechanical — Gas Tank — Gas Piping — Shutters ;✓Windows/Doors.;
Electric-. ✓plumbing... —Sprinklers Generator7�7 .,:
:Roof
Total Sq. Ft of Construction: 13$ Sq. Ft. of First Floor
Cost of Construction:$Utilities: —Sewer- ✓septic .Building
-Height:
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Name Cc rL4 TarV
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Name:-;�rcd,� 17j u,-,C,rsw
Address:So2Uo
Company: '
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City: FT- State:f-�'t
Address: 19-2y 01 L I-Ac5tlyn
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State: �.
Zip Code: 3 y gig? Fax:
City: r
Phone No. '7% Z
Zip Code: 'Fax:
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Phone No. "7Tl_ d 1 --7 74%/�11
17 ij'b�` 7 J3
E-Mail: P Vt.
Fill in fee simple Title Holder on next page ( if different
E-Mail: �
(f' l .n eov►_14:1
, (cu Lto L , co. -I
State or County License: iz(3 11111100
3 62 f
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:-i�lii-��C-:i-��rr ��nc-
Address:_gp(o 1DeLa u.a r'-c -t-v-,(- :'
City: Z= State: L
Zip: 2)445-0 Phone: •:Z 7Z 'f ( 7 7!
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: I
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: Stater
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 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF uo, IE
COUNTY OF
The f r oing instru nt was acknowledged before me
204
The forgoing instrument was acknowledged efore me
this day of by
w
this day of ..20Lby
'
(Name o p rson c
(Name of person acknowled i
KAREN S. NIELSEN
`eon'
„����,,, �., KAREN S. NIELSEN
,,`'Fr 'v,(' # FF 115637
c Commission # FF 115637
My Commission Expires
;�� �: Commission
'O My Commission Expires
.,, a�?
(Signature
(Signature of Nota
/
Personally Known J OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced -
Type of Identification Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. //LU14
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