HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IIN/FO{ MUST BE COMPLETEDTOR APPLICATION TO BE ACCEPTED
Date: L b ' I� I ����� Permit Number:
• L—RECEIVED.
Building Permit Application Planning and DevelopmentServices 018
Buildingand Code Regulation Division2300 Virginia Avenue, Fort Pierce FL 34982 Permitting
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial Resid
PERMIT APPLICATION FOR: TO*Iect from dropbox, click arrow -at the end of line
PROPOSED IM'' 11PROVEMENT LOCATION:
Address:.gy L"1 (�+tl�.\QfA CO3),- r-4 91ercQ_ r-r c195
Legal Description: LAec c qL-)6di2> y r\,: 'k- Oy Kok kA
Property Tax ID #: 133�-( �� 13" Ootk�= - 600- Q Lot No.
Site Plan Name: ! Block No.
Project Name:
Setbacks Front Back: Right Side:_ Left Side:
DETAILED DESCRIPTION OF/ WORK:
CONSTRUCTION INFORMATION:
Additional work to nGasTank
ormj under this permit -check a apply:
�HVAC- E]Gas Piping Shutters' Windows/DoorsElectric" Plubing Sprinklers Generator -Roof ® Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: 3-10y� '
Cost of Construction: $ O� l,1,100D Utilities: Sewer Li Septic Building Height:
OWNER/LESSEE:. '° j, '
CONTRACTOR:
Name
Name: f,4N+U 6311.
Company: ShOtae (+ C',Y-QrnL_1�
Address: cl'-1�1t7-i1J�C ��nA C mp4
City: P tie_ i State: j�-(
Zip Code:.3L151 1 Fax:
Phone No.^l ,� _ 65N'� 7
Address: / 76 60 GiO�Qkpll 6
City: -PbO 61 1 JL er State: .
Zip Code: 'ZLA i ao% Fax:
Phone No. 7-ra o*X_0 R56
E-Mail: I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: e?,wa(7cd
State or County License: UG 1�31 I-10
If value of construction isl$2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION`
DESIGNER/ENGINEER:
Not Applicable
_MORTGAGE COMPANY: _ Not Applicable
Name:
I
Name::
Address: I
Address: I
City: :
State: I
City: I State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COM�IANY: _Not Applicable
Name:
Name:
Address:
Address: I
City:
City: I
Zip: Phone:
Zip: hone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit io 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 per it holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and cov6nants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for anyrestrictions which may apply.
In consideration of the granting of this requested permit, I dolhereby agree that I will, in alrespects, 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 rl view: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses :suit
o another non-residential use
WARNING TO OWNER: Your failure to Record a Noticeay lof Commencement mr in your paying twice for
improvements to your property. A Notice of Commencement must be record d and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lendbr or an attorney before
comfne�nNruz work or recordinowour Notice of Commencement.
-C
Signature of Owner/ Lessee/Contra fora Agent for Owner
Signature of Contractor/Lic nse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �U
COUNTY OF
..�F
The f r oing instrument w acknowledge before me
this day of � 20Z by
The for ing instrument was cknowledge before me
this day of 2011
0 I1 by
RLt )I
d'LA Lin
Name of person making state ent
Name of person makiri stat nt /
Personally, Known OR Produced Identification
'
Personally Known OR roduced Identification f/
Type of Identif "tion
Type of Identification
F (,
Produced h
Produced
y-----
(Signature of Notary Public- State of Florida)
(Signature
(Signature of Notary Public- State of Florida )
Commission No. .,��„°��(, 1<F(ftN1 S. N I E LS E N
mmission No.
Ci Commission # FF 115637
�`tP Yaks
a KAl2. hl S. NIELSEN
= my Commission Expires
3, .'- Commission # FF 115637
-
IR
Mv
`
%
.,
I June
12
REVIEWS
FR
SUPERVISOR
PLANS
VEGETA
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
RENEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
I
Rev.8/2/17