HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI' D FOR APPLICATION TO BE ACCEPTED
Date: !, �' � � Permit Number:
-x` E
A���
Building Permit Applicatio Nov
7pe
Planning and Development Services
Lucie Co
Building and Code Regulation DivisionST.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:i.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: SCANNE
�":4j ca�,'�i M
k
�13Sf l 1
.fMO�0
-....✓..�rs�,,..,-."`,,,'d,�,
Address: E
\\
�(� Vt� � il�ou
Legal Description:' o AL ( ,�
�w �� �� .'� Z Lot No. i
PropertyTax ID #:2= )
Site Plan Name: Block No.
Project Name: nLI-2 a oi0
Setbacks Front Back: Right Side: Left Side:
I
N�' b ' q ,rye 3ro r? m
lb
� �
�I LEI13E �
3aw'�..
- b R.. 3�ve �'�.�rx
�� � � ` _
�Q ( VV\C' J1nu Cly���
1 1 c '
k,
`^
romp �yz�°f.`3.L h �raY+ i8i �.0 %4
Elm
-
Additional work tone per orme� uncler this permit- cneCK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
I
_ Electric _ Plumbing —Sprinklers _ Generator . _ Roof Pitch
Total Sq.IFt of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ L �Z- Utilities: _ Sewer _ Septic Building Height:
A �w �% x a ;
�f3lltt�RLESf�� ����
Ad4
Y .. .*. .: =4°. ti:�,i's�',C',
tina��Sa'�a.� a`S� s
.Name
t Name an -
Address: Company: ,�m6�.� AJo,1( nC Q (0,
City:, An A7 0 ' State: Address: 3Wl � 1 > r
Zip Code: Fax: — City: J 49IP CZ._P State:
Phone No. Zip Code: 3-6, &_7 Fax: '
-- 1-L- s---i
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail a ca
from the Owner listed above) State or County License3 �. T 9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: -Name:
Address: Address:
City: State: City: State:)
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 intend to obtain financing, consult with lender or an attorney before
commencinig work or recordine vour Notice of Commencement.
Sign a re of Owner/ Lessee Contractor as Agent for Owner
Sign —at ur Contra or/Lice se Holder
1
STATE OF FLORIDA I
STATE OF FLORIDA
COUNTY OF LCOUNTY
OF
i
The rgoing instr ent was acknowled before me
The rgoing instr ent was acknowledge before me
this day of 2t by
this q day of Lijoy 2016 by
i
(Name7 of person acknowle Bing)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
(Signature f Notary Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi n
Type of Ident' ' n
Produced
Produced nrrl, -LSEN
KAREN S. NIELSEN
a° °°6^State of Florida -Notary Public
`�
Commission No. ;:� ,:State of Ffp" Crary Public
G 207404
Commission et �� Commission # GC49@2184
�, Expires
�• •= ommission # �3
MY Commission Expires
�, mission
���I11����
June 12, 2022
2
REVIEWS
FRONT
ZONING
SUPERVISOR®R;=E�;
VEGETATION
SEA TURTLE
I
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
f L,
Rev. 7/2014