HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONL
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: I �. ��
BY
St 'Lucie CountyR �;.^,r' fin. ((; ,
-� �cw sn-c t1 7J - 4
Building Permit Application DEC 2 9 2017
Planning and Development Services
Building and Code Regulation Division PERMI", NG
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie unty, 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
PftOPOSED,iMPRO"VEMENT LOCATIQNi
Address: 1
Legal Description: am/ cee- Lod 2U
r
PropertyTax ID #: Lot No. W
Site Plan Name: �PA LinS Block No.
Project Name:
Setbacks Front WA Back: S' Right Side: 10" Left Side: 0'
DETAILED DESCRIPTION OF'11VORK
ePIGCs? bc3fi .SCc ears (J a f l Ole) 5 cfS
CQ.NSTRUCTIQN INFORMATION
Huumunal wofK LE) De eiTofineu unuef L1115 PCUMIL-GneQC [I11 rn dp[Jly.
OHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
0 Electric E]Plumbing U Sprinklers El Generator F Roof Roof pitch
Total Sq. Ft of Construction: 30� S . Ft. of First Floor: -W
as
Cost of Construction: $ ZZ/ 9CO Utilities: Sewer F1 Septic Building Height:
011171VERJ'L�SSEE
F ;m
CONTRACTOR"
Name M; ke JWO hbA
Name: (J-VAo
Address: 1 Cry
Company: ALWO Lak4223_45, --')'C .
City: K;e n State:
Address: l �3
Zip Code:.3K5;1 Fax:
City: Psi 5� W State: 'I•
Phone No. (2:�B- z�4I?r 11 1.8
Zip Code:'-;,Ltgb9 Fax:
E-Mail:,BL,Tz,*', 1S na 1S tlIrhW^1. WnA
Phone No. 51� C,2go
Fill in fee simple Title Holder on next page ( if different
E-Mail: r W6,A, Aowo4r=, f,,.;1ram►
from the Owner listed above)
State or County License:
if value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: —
Not Applicable
MORTGAGE COMPANY:
— Not Applicable
Name:
Name:
Address: QSO SSyl4�,n a�n
Address:
City: ?,sr} 5-+• Luc le-
State: !.
City:
State:
Zip:.'skafs. Phone :142-
RET-A 432L-f
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 inr�tend to obtain financing, consult wiT lender or an ttorney before
c,i'& commenwork or refefc(in>? vir Notice of Commencement. %
as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF , . L) u (% I COUNTY OF
The for ing instrument was acknowledge before me
thisday of 20by
Name of person making st tement
Personally Known OR Produced Identification
Type of Identification ,
(Signature of
KAREN S. NIELSEN
Commission No. Commissi4&eel)F 115637
°.tee My Commission Expires
June 12, 2018
REVIEWS I FRONT I ZONING COUN ER REVIEW SUPERVISOR REVIEW
RECEIVED
COMPLETED
Rev. 8/2/17
The for g inst ment was acknowledged before me
thisday of 20117 by
f2 pKI kmt)N 6
Name of person making statement
Personally Known OR Produced Identification
Type of Identifi�On
Produce_L___�
d j^_L— __—
(Signature of Notary Public- State of Florida )
Commission No. ;:R'"�B°.; K(M61� S. NIELSEN
Commission N FF 115637
�'��oFr�°44�� My Commission Expires
PLANS VEGETATION SEA TURTLE MANGROVE
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