HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-
ALL APPLICABLE INFO MUST BE COW,"' rED FOR APPLICATION TO BE ACCEPTEC
Date: I iv • ,v SCANNED Permit Number- AAr*
BY
` A._4z St. Lucie County RECEIVED
Building Permit Application JUN /6 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 *Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: I . )4b -
Legal Description:
Property Tax ID #:
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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rouwuvnm WUM w ue eTIUMMa unuer uus pernuc-cnecK au apply:
- ❑HVAC Gas Tank , as Piping Shutters ® oors
®Electric FIPlumbing FSprinklers Generator ®Roof
Total Sq. Ft of Construction: 7 Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: 0Sewer ®Septic Building Height:
OWNER/LESSEE':,}
Name AKsv�_ 4,,.c
Name:
o' ' Lo E
Address: /A4ecsa 1-4ez>o-"-4,Ca6-t gfrB. s_ __
=Compan =�: }(�]/s?itl ee ]5mzf
city: 7oax ST L,)c.0 State:;. -.-
Zip Code: 3 c(7 S_U Fax:-17a.- 3310- I4�o9..%
Phone No. % - R73 - &orY �. _Zip
'Address._18,1 "'PP'Iillika �uP
_Gty pSL . '_ Ij State:_L
Code: 3Y453 Fax: a J)
Phone No. (777 .776- 8Y 4 (n
E-Mail• o"S.
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: go ✓�C&& y"e0• C o.l,�
State or County License: 19 L/3
If value of construction is $2500 or more, a RECORDED. Notice of Commencement is required.
'SUPi'LE�tiEi�1TALM{}�dS�L3tJ' JNrLIENIAUU{NffilN�,4T1QN
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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
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 willauthorize the permit holder fo 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 1 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 applicationsare exempt from undergoing a full concurrencyreview: room additions,
accessory structures, swimming pools, fences, wails, 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
commencrn—g—w-'Ork or recording vour Notice of Commencement.
00mmun 14-3
_ Signature
STATE OF FLORIDA STATE OF FLORIDA_ 1
COUNTY OF u r COUNTY OF �1 L 11C1�,
The fo oing instryme�nt was acknowledged before me The forgoing instrument was acknowledged before me
thisdayof Y"1116
20 LLOby this -dayof )i )WE, 20 )�__ by
l
(Name of person acknowledging) (Name-6f person acknowledging,) -
(Signature
State
Personally Known OR Produced Identification
Type of Identification Produced �L d>!—
Commission NoArqqaS�
Revised 07/15/2014
of Notary Public- State of Florida )
Personally Known OR Provednffcation V
Type of.identification Produced
-RAI"tEN S. NIELSEN
Commission # FF 115637
June 12, 2018
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