HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IV C 11 L6 Permit Number. I LV V �0^ 11` n'l
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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St. Lucie Countv
Building Permit Application JUM 0 12016
- PEP.'dITTING
St. Lucie County, FL
Commercial X Residential.
PERMIT APPLICATION FOR:
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1?1tOlyOSEQ IPRdEl1€fV LOCATibNsY, VY y
Address: 3 L�iyl
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Legal Description:
17 3!-I H d Fro, "
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CO (Z pP 5 &- e u A/ S -Z3l -1 F
Fat P o f�
. 7tf ter' 3 1. �l F i
Tu
u • s . i , T7+ seL ' I a l M -tH nir4v 7?15 P= i
IDY- - lyl7-11t-0006--060-- Lot
Site Plan Name:
Project Name: _
Setbacks Front Back: Right Side: Left Side:
Block No.
_Mechanical _Gas Tank-GasPiping_Shutters —Windows/Doors - e
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:_f
Cost of Construction: $ I S 1)
T�
f 1 Sq. FL of First
Utilities: _Sewer _Septic Building Height:
t)WNE LESSEE, �,� � = M,{t�. � ,`
CON'fRACi'DR ` � ¢� � `` ��•
Name V02-✓\
Name S(�dJr�t n�
K
Address: K51
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Company. bP, sVC-f- V7,
r inn' 1 i 4-
City: V-�-Ar V
Zip Code: 3 Zji 6 Z- Fax:
Phone
State:
Address: 7 g T- I i L 0%
NiJ I
City: V ere LSee C h
Zip Code: 314foC
PhoneNo7.7i--32( 7S2-C
Stater_ /
Fax:
E-Mail:
Fill in fee simple Title Holder on next page (if cliffs`"rent
from the Owner listed above)
-E-Mail�5
C-i-14icu /'-t
State or County License
n vaiue or consvucaon is vuu or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE -COMPANY-
Name:
Not Applicable
Address:
"
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
Stater
FEE SIMPLE TITLE HOLDER:
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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
no
.e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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 concurrencV 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
commencine work or recordine your Notice of Commencement.
Sigrfature of Owner/ Lessee/Contractor as Agent for Owner I Signitmis of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �J- LONE, COUNTY OF . a- I - (�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this
this I.) 1,�E• 20l by this l day of IuIJF, 201L by
moo, �If1��h�. ►t)�IS�P�
(Name of person acknowledging) (Name of person
of Notary
Personally
Type of Idi
Commission
ate of Florida)
(Signature of Notary Public -State of Florida )
Produced Identification
Personally Known
OR Produced Identification ✓
Type of Identificatio
d �D'
EN
"> KAREN S. NIELS
,o,. •„,,, KAREN S. NIEL
Commission # FF 1
Commission E
2018
37 ton NO. '%' I
pifg� _
;
_'q -' Commission # FF 11.
Om
mission
�,�g o�«oos;: mission Exp
June 12. 2018
June 12,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER IEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE (f
RECEIVED �� / A
DATE C�
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