HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII APPLICgABLLEE IN O MUST BE COMPL'c, �J FOR APPLICATION TO BE ACCEPTED
Date: 1 oC Permit Number:
SCANNEDBY RECEIVED
St. LUCie COuntV JAN 2 12016
s i �
Building Permit Application PERld111MG
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential
Address:
Legal Description:
Property Tax ID#: 1410 - Y113 - 000 = ��C)®-o`Z Lot No.
Site Plan Name: �/^1 ( Block No.
Project Name: VT 1 ,C_ l ASCt±- cS
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION:
,.: .. •. to �.
ACloitiona�tic 6e performe un er t is permit�.0 ell t at app y:
_Mechanical _ Gas�Tank _ Gas Piping _ Shutters _ Windows%Doors
_ Electric _ Plumbing Ksprinklers _ Generator _ Roof
Total Sq. Ft of Construction: - Sq. Ft. of First Floor:
Cost of Construction: $ 1000 ey G Utilities: _ Sewer _ Septic Building Height:
C+ViJNER/LESSEE:
4 ;
CONTRACTOR:,
Name S21h E
rAtJe(S TviG;
Name:
t✓�
Address:
Company: G09kV02 rbfC2 �TeC " ✓� �i�
City: VZ
Zip Code: 3o�I Cl �p Fax:
Phone No. '-7 22 - 5-6 7
State:FG
add
Address:Tby"�Ox 700f-s-iP
City: OW\6 SSO State:FL
Zip Code:.39 � %D Fax:
Phone No 7 c2 ),2 -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �% (JA+C r f e-e_ 12lei l4 ' o Lk,
State or County License o2 iP _3g Y
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
4
SUPPLQAEN717 CONSTRI}crrON LIEN LAW INFORMATION
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
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 pperrrlit;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 fir ion, II nd to obtain financing, cons or an attorne fore
.. •. rrli r,oneNnrirp of Cnmmenremer6__��-�
Si tore o wner/ Lessee/Agent
Si a of ntractor/Lice se Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY O
COUNTY OF
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this�dayof��zo�by
thisaldayof JAkIU�20-itoby
l i VIA mANM S
A ,W<AIX� LLISu �I
_)LU
(Name of person ack owledging)
(Name of persona nowledgin'-'
J
(Signature of Notary blic- State of Florida)
(Signature of otary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced L '^e;.. KAREN S. NIELSE
!of Identific n
r uced f .L• °'. "'. KAREN S. NIELSEN
o•�P
Commission N FF 1156
Commission 8 FF 115637
7
�_
;�� a°p`(S ay ommission Expir
Commission No. 9.'4"4..o•` June
_ _ = mission Expires
sip mission No. ,,+:c`' l��j� a 12
;,,,o• 2018
12, 2019
,,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
COMPLETED
Rev.7/2014