HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �I��U. ) �z/
Gl / Permit Number: I O rIJ
Building Permit Application NOV 6 � ...:;
Planning and Development Services
Building and Code Regulation Division PER • '
2300 Virginia Avenue, Fort Pierce FL34982 St. Lucie FL
Phone:.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
S;ED;IIVIPRgVEMENT LO'CATI;O`N
Address: /p!! J _
Legal Description: s-eY
7I v�w.L v\ r 7� d 7 If O^y
Met 5 ko- /U (0P itl7—
Property Tax ID #:-3321(P O I —y O r% D C;' —�, Lot No.�
Site Plan Name: n WBlock No.
Project Name: S Vl ,O W
Setbacks Front Back: Right Side: Left Side:
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G'PNSIT RATIQN ��>
Additional work to
be nertormed under
this permit —check all
that apply:
11HVAC
Gas Tank
❑Gas Piping
_
Shutters
Q Windows/Doors
Electric
0 Plumbing
❑Sprinklers
1:1
Generator
L]
Roof
Roof pitch
Total Sq. Ft of Construction: nq
Cost of Construction: $ 1 �3 \ o
S Ft. of First Floor:
Utilities:Sewer 0Septic
Building Height:
®VUNsER/LESSEE
- CONTRACTOR
Name e� D
Name: 1 r m
e
Address: 05 —
Company:D{%T7-�c�r C ri'e S,� ffe�,`IG
City: G State:
Address: 3100 A), -z iyj
S � bok t4
Zip Code: Fax:
City: FJ f 4 Pie yc eG
T
State:_��
Phone No. 72 • /� 3
Zip Code:
Fax: 7%2- 9V- 4$9d
E-Mail:
Phone No. ?Z
S S
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License: o9
�,4-T
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL"CONSTRUCTIONyLIEN LAININFORMATIO.N:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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 Noticp, of Commencement.
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Signature Owner/ Lessee/Contractor as Agent for Owner SihAiture 6f Contractor/License Holder
STATE OF FLORIDA STATE OF ��/�/� COUNTY OF FLORIDA /'/�/�
COUNTY OF
The forgoing instrument w s acknowledged before me
this j day of 20 I by
- Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced "I _ I r%
The for oing instrume pt was acknowledged before me
this y day of &OV 200 by
M1 [�4 nw A5KC I
Name of person making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced n.
(Signature of No ary Public- State of Florida
of Notary Pu
(Signature ry
X 2T ; K
R N S. N I E LS E N
Commission No.
�o,
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KAREN �C N+ELSEN
fY� 115637
=+° `�= Com i n # FF 115637
Commission No. _* *
M Expires
missio
=• •1 Tres
My Commission Exp
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fission p.
June 12, 2018
June 12, 2018
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS VEGETATION SEATURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW REVIEW
REVIEW
DATE
RECEIVED
COMPLETED
Rev. 8/2/17