HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
SEPTQ,2018 SCANNED
Permit Number:
H
Building Permit Application RECEIVED
i and Development Services
and Code Regulation Division
ginia Avenue, Fort Pierce FL 34982
(772) 462-1553 Fax: (772) 462-1578 Commercial R
SLP 95 2018
ST. Lucie County, Permitting
PERIYIIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED
IMPROVEMENT LOCATION
Addre�ls: 300 N HEADER CANAL RD
Legal Description:
12 35 38 W 467 FT OF SW 1/4 OF NW 1/4-LESS S 185.5 FTAND LESS RD AND CP
Prope
Site PI
Projec
Setba
y Tax ID #: 2212-233-0005-000-8
i Name: NICHOLE L. SIMMONS
Name: NICHOLE L. SIMMONS
<s Front Back: Right Side: Left Side:
D,ETAILED�DESCRIPTI,ON OF WORK.:
4
Lot No.
Block No.
CONSTRUCTIO-N MNFORMAT1, N,,-
ditiO'nal work to be nertormed under this permit — c ec a apply:
�HVAC Gas Tank as Piping _Shutters Windows/Doors
lectric Plumbing Sprinklers Generator Roof
Total S Ft of Construction: 1200 S . Ft. of First Floor: 1200
Cost of Construction: $ 6000. Utilities:'nSewer Septic Building Height: 8
'OWN'ER/LESSEECONTRACTOR
^'>
Name li
Name:
Address: 300 HEADER GANAL HD
Company:
BLVD.
F
City:
iState:
Address:
_
34945
FORT
Zip Co
Fax:
City:
Ile:
���2
34951 -468t0=
Phone
No.
Zip Code: Fax:
Phone No.
E-Mail:
Fill in f le
simple Title Holder on next page ( if different
E-Mail: jgCar1r10nr00 IC OU .COm
29914
State or County License:
from the
Owner listed above)
l
If value 6f construction is $2500 or more, a RECORDED Notice of Commencement is required.
c,
SUP,LEMENTAL'CONSTRUCTION
LIEN LAW INrORMATI{{ON
! F„ N�,y+'i, iii5 ,.,<¢ #„ . •f , L< 3. .Nr Y6 V
DESIGNER/ENGINEER: Not Applicable
Name: COOK&MENARD A
MORTGAGE COMPANY:
Name:
_ Not Applicable
Addre,
Address:
�;
City:ERCE State:
City:
State:
Zip: , Phone: 712460175 1
-1T
Zip: Phone:
FEE SIMPLE
Nam91
Address:
TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
III
City:
City:
I _ Phone:
Zip: Phone:
Zip:
that no work or installation has commenced prior to the issuance of a permit.
St. Lucie�e County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which it', in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structue. 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 acco6ance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foll ' wing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessolry 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
befom,Ithe first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signat'u a of Owner/ Lessee/Agent
STATE 1IOF FLORIDA t
COUNTY OF J
The fo ing instrurrient was pcknoluvledgeq,4efore me
this day of 20 by
ame of person acknowledging
(Signat re of Notary Public- State of Florida )
Personallliy Known OR Produced Identification
Type of Identification P=^d
n No.
07/15/2014
Signat re of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrurnent wa acknowledge efore me
this day of 20 by
in CA
(Name of person acknowledging)-
- T U!Lkk mot/` V. Ufa- A I YL�
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produuoed
KAREN S. NIELSEN Commission No.
State ojl beRi a -Notary Public
Commission # GG 207484
My Commission Expires
KARENS. NIELSEN
State gQida-Notary Publi
Commission # GG 207484
My Commission Expires
IS
REVIE
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPL
,TE
INITIALSI'