HomeMy WebLinkAboutBUILDING PERMIT APPLICATION2
ALL APPLICABLE �ZS
CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �A- ti-J . Permit Number:
5GANk6FW,
RECEIVED
guifding Permit Application APR 1 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie u ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 J Commercial Residential
PERMIT •AP_PLICATION FOR: To Select from dropbox, click arrow at -the -end of line
PROPOSED •IMPROVEMENT LOCATION: -
Address: )02 SVA'J'ya'`' Jii� Jf:
Legal Description: L-4lEvJOCO 1 W -I 0,,J 17 IY3 &)T 9 6qW %3 / Z N) OR
C 3 2 �8 ^ I936- ,z` 3S`I a —Z� 360.�f - 2 36
Property Tax ID #: 1 301 - 06,0 I Lot No.
Site Plan Name: Block No. 153
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPT)—OW-6 `F WORK': 7 7°_.�__�.._ a,_7_
/iifA01 0°L/>; j/( L5ro /.v G oJE� -%l 6 do R e f iou e
CONSTRUCTION INFORMATION;(
- .
Additional worK to be nertormed under this permit - check
❑HVAC Gas Tank
— []Gas Piping
all
that apply: •.
_ Shutters
Q Windows/Doors
Electric Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:
J
r
Cost of Construction: $ 5 > /oo I
I
Utilities: _
Sewer
0
Septic
Building Height:
i
OWNER/LESSEE:
CONTRACTOR:_
Name Slw),Jy E)UQi i_ "- LLB
Address: I & Mcaa oW t-n1
Name: 68627 CJ1U4ti _r
Company: Soo yYi 5lo(_C &;sK4grAs
City: /1401U 15 I State: II
Zip Code: & O q S-O Fax: ���j!
Phone No. gi S 9 V Z - 3 S0
E-Mail: God` rlSlf r.-JG $ 7-1 40P*00 . 4!�oM
Address: j y o I �£ ,,docb O,(
City: ft f iEkCC_ State:
Zip Code: 34 9,1 Fax:
Phone No. .] 72 J 81'
Fill in fee simple Title Holder on next page ( if different
E-Mail: Ko$ W 1 u-I ✓W S 5 & &6t (,Sou711: AJ�
from the Owner listed above) I
State or County License: 66C 05 % 7 Z-Y
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION L'IfN LAW INFORMATION ' .''--
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
I Address:
City:
State:I City:
State:
Zip: Phone
I Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
X_ Not Applicable
BONDING COMPANY:
4Not Applicable
Name:
Name:
Address:
I
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
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 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 per1'mit, I do hereby agree that I will, in all respects, perform the work
in accordance with theapproved plans, the Florida Building.Codesand 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,lsigns, 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 wtop6or recording vour Notice' of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The fo oing instru ent was cknowledge efore me
this day of 20by
Name of person making statement
Personally Known OR Produced Identification
Type of Iden "tion
-Produced 1 4, 0 L _ I
(Signature of Notary Public -
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
<A EIN S. NIELSEN
ission N FF 11563
My Commission Expire
June 12, 2018
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 4.
The May
ng instr ent was acknowledge before me
this of 20 t 0 by
Name of person making statemen-' t
Personally Known OR Produced Identification _
Type of ldentific i fl
Produced
4,,ignature of Notary Public= State of Florida )
mission No. ! •" I<AL.A.SNIELSEN
Commission # FF 715637
My Commission Expires
FRONT ZONING COUNTER I REVIEW J�SUPERVIS REVIEWOR I REVIEW NS I VREV EWON I SEEV EWLE REVIEW