HomeMy WebLinkAboutBuilding Permit Applicationj1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a �� Permit Number:
t _
• Building Permit Application
PFRM1l1-i'IPlG
Planning and Development Services 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 A.. O.
Address: 2617 Grceh bnC _ C r
Legal Description:
Property Tax ID #:(1011 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
pertormed under tnls permit— cnecK all Mat a
_Mechanical _ Gas Tank
-V =lectric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 16430 �J
_ Gas. Piping _ Shutters _ Windows/Doors
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic . Building Height:
4WNE /LE=�SSEE
CONTRA ®R:
Name RG hez L i 1JSIy
v�
Name: �rl LjdVVeAl
Address: 76l8 Ere h✓��;�-- Gor
City: S} W C(e State: -
Zip Code: cl g� Fax:
Company: 1�1i mew PSI MY72 '
Address:'92 ° S V '30V
City: �4�r Gilty StateFt
Phone No. 1 �72 L/y $ $130
Zip Code: SY 19 0 Fax:
Phone No q6 7 760 2 37 3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail Frf'k /- ll ek1 '2q7 e c�Mqj .CGS^
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU°',P EMENTAi.CON�STRt�'�TtQN LIEN LAW I`N'F+'RMATIDN:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
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,ER: Your failure to Record a Notice of Comm(
improvemP t yo r property. A Notice of Commencement r
before thest}}' sp ction. If you intend to obtain financing, cc
commencing vv`ork dr recordinp- vour Notice of Commencemen
r/ Lessee/Contractor as Agent for Owner
result in your paying twice for
Jed and posted on the jobsite
4er or an attorney before
Contra ctoOLicense Holder
STATE OF FLORIDASTATLORIDA
!_, L6�(',11� COUNTY OF 1) �I��
COUNTY OF
The forgoing instrument was acknowledged before me
this day of ti 20fn by
S?—A V— 1�11 k1c W elm
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identifica ion
Produced F 1 _ �)• L - — —
The forgoing instrument was acknowledged before me
this day of bi 20-a by
(Name of person acknowledging) _
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
B`��-
ItAREN S. NIELSEN
It Fr- 11563r
No.
�• s,,. �_„
Commission No.
(Sreal�ission
My Commission Expire,
mmission
_A _ NIELSEN
Cornmission
JunC' 1 2. 2018
-
,_
,tF, v;\5-�, pny C # FF 1 1 5
.k `/jam F4L��4`\.� ommiss, 63
-
o= unF 12, 2018
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS VEGETATION
SEATURTLE
COUNTER REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED