HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: it) 1. I %
Permit Number:
Building Permit Application , Lf
Planning and Development Services OCT 2 7 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PERNiITTI�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResidMtL*ie Con ty, FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMP,ROVEM N OCATIQN A _ y�T.1K!
Address: 7 00 5 g roo R Z i A e-lava- , Fol- • Pl e-rGe rl_ 3-11q5-J
Legal Description: /LaKe W000i PzdL - (AnW % " lean k 10&^ / t)f a I (map 13/0 /N)L0237S9-1
L&L2I 916cK106 IaKewood �crK-UPI+-q,�ccard�yl t ePram6a> eoC-A? dedto %�lak/,tQ4e il
Property Tax ID #: 190 l - 611-6126 -Wo f 2 Lot No.:?I
Site Plan Name: �ij7_ Igo kakse Block No. 1 D(o
Project Name: /1Jpw VI'te*&t "0 t-
g 10 d% Ci 8y
Setbacks Front 30.1`1 ' Back: Ri ht Side: Left Side: ,
1rS�all A%w 26 9&&,9e `t"ouyF. V'.6 me+-o-1 Roo(-' over 3 &6 s�►/���s
CSIn91e�acBer� !r< lice&_dGree Wrf-� rlorjo_ f�0dtLcf �ro✓a,( # l37�3�?
Mitional work to be ertormed under
❑HVAC Ei Gas Tank
0 Electric 0 Plumbing
permit - cnecKan apply:
Gas Piping _ Shutters
Sprinklers Generator
1:1aRoof
Windows/Doors
Roof pitch
Total Sq. Ft of Construction: ;9 g GG Sq. Ft. of First Floor/ -2276
d ❑ �
Cost of Construction: $ ,; /00 0 Utilities: _ Sewer _ Septic Building Height: /5
NameToLr,
Address: `166 5- 0i 6o 0%r0- AVe-
City: V t ea e State:
Zip Code: %4G5 1 Fax: AIM -
Phone No. -172 - Br01- 3359
E-Mail�a�.n S6Jevi Sq k6- Mtxl_I , UM,
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:.
Phone No.
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Fax:
State:
SUTRU PPLEME(TAL co LIEN LAIN INFORMATION
a
r
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name: Ngc,s+crr Qav-,V,
Address:
Address: mr-A S C I IS-30 SISI 604 cafe 1T'h
City: State:
City: 'T as State: M
Zip: Phone
Zip: 4 go —AUfhone:_ Do7200
FEE SIMPLE TITLE HOLDER: of Applicable
BONDING COMPANY: _ of 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
commenciniz.work or recording our Notice of Commencement.
Si nat of Owner/ L see/ ontrac r as Agent for Owner
Signature of Contractor/License Holder
STA OF FLORIDA
STATE OF FLORIDA
%COUNTY OF
COUNTY OF
The forging instru t w acknowledged before me
0
The forgoing instrument was acknowledged before me
this day of 20_ by
thiday of 20V by
Name of pers an making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification
Produced l..
Produced
(Signature of Notary P -
(Signature of Notary Public- State of Florida )
�. ��n••�a0y KAI�??EN S. NIELSEN
Commission No. ;+° `�': Co Won S FF 115637
Commission No. (Seal)
=* =
A.,= My Commission Expires
June 12, 2018
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Rev. 8/2/17