HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE'rcv FOR
Date: c9� 21 i
)PLICATION TO BE ACCEPTED
Permit Number: (Ql S
SCANNED
Sy
St bide, Cflwit ll
RECEIVED
ilding Permit Applicatio
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Reside
MAR 21 2018
ST. Lucie County, Permitting
ntial t/
PERMIT APPLICATION FOR:
.7PROPOSEd'lltidraRov�INT LocATIC}I
Address: Cc
Legal Description: eiv9�i
Property Tax ID #:
Site Plan Name:
Project Name: rb ,
Setbacks Front Back:
0
M.A
Right Side: Left Side:
gDETAILED DESCRIPTION pl=1NORK• l .
YY1-=-�II
yzr�G2_ 4cil iS�'�e
Lot No.
Block No.
l s, ew 44 Sri d Q�
CONSTRUCTION" INFORMATION` i.°
.
.
(
Additions wor tov a per orme un er this
permit
— c ec
all that apply:
_ Gas Tank
_
Gas Piping
_ Shutters.
_Windows/Doors
_Mechanical
Electric Plumbing
Sprinklers
Generator
-2� 1/7
t-- oof Pitch
_
Total Sq. Ft of Construction: ��
_
_
_
Sq. Ft. of First Floor:
' 12
.
Cost of Construction: $
Utilities: —Sewer —Septic
Building Height:_
Name va( .-:1 ,Name:Ty_, . — Chu �-� 9r_o 1111
Address: Company: t2-_kYYLV41 ! tA,02
City: Stater— Address:.
Zip Code: Fax: City: S Stater
Phone No. (a 2) 21 CA 0J000 . Zip Code: Fax: 61
E-Mail: Phone No33����(%3ti(y(
Fill in fee simple Title Holder on next page ( if different E-Mail 12�n-�SQsr'�c®
rs)cu �r n
from the Owner listed above) I State or County License I l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPI E�MNTA CONS'RU TI(3N L1N LAW INFaRMT�tJN.
a
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable -
Name:
`
Name:
Address:
Address:
City: State:
City: State:
Zip: - Phone
I
Zip: Phone:
FEE SIMPLE TITLE; HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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 such
prohibit
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, recor ed and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lerider or an attorney before
commencing work of r ording your Notice of Commencement. A
Signature of Owner/ a e/Contractor as Agent for
Owner
Signature'of Cont /License Holder
STATE OF FLORIDA
STATE OF FLORIDA p,
COUNTY OF
COUNTY OF '; UJ C
The forgoing instrument wa acknowledge efore
me
The f r oing instrument s acknowledge efore me
�
this day of IP\Y 20 by
this day of 20 by
(Name
(Name of per n nowledging
of person acknowledging
1 �
r, I. �—
(Signature of Notary ublic- State of lorida)
(Signature of Notary Public- St to of Florida)
/
Personally Known OR Produced Identification
✓ ,/
Personally Known OR Produced Identification V
Type of Iden if' cation
Type of Idention
Produced
Produced
,,,, F, F,,,,, I<AREN S. NIELSEfV
Commission No. .�`1=a'°°B,'�-, �%)� FF
Commi
1�15637
'a`� ���"= KAREI�j S
Commission No. q p` mmi�,�g�l��i6LSEN
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My Commission
ExP res
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ExPires
=9, one 12, 2Q18
-June 12
REVIEWS
FR
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MA E
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE'
RECEIVED
DATE
COMPLETED
ev. 7/2014