HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� l
Date:rIQ9. 15 Permit Number: 1 5 1 2y "1
RECEIVZD
DEC 2 9 2015
Building Permit Application
PERMITTING
Planning and Development Services 5t. 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
PERMIT APPLICATION FOR:
PR(JPOSED IIVRROV
Address:
EMENT LOCATION Y{
Y mot t i' �1l c!'>r' Z ZZ j
Legal Description: of w �o CSA 110 Z1 6( (A(C lq6 T 1(4
Property Tax ID#: 3 3 00 37 d OCA Z Lot No.
Site Plan Name: J Block No.
Project Name:
Setbacks Front -Back: Right Side: Left Side:
DETAILEDDESCRIPTION£OF
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Y
S,
,
CONSTRUCTION INFORMATION }
Additional work to be pertormed under this permit-check a -tat appy:
_Mechanical _Gas'Tank _Gas Piping —Shutters, _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
�o
Cost of Construction:$ 5:-7 Utilities: —Sewer _Septic Building Height:
01t1lNER/ryLESSE ' CONTRACTOR r5
End
e
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Name 1�'l '� RI.; Name:.
er -I ��o
Address: $3111. P10/115'1Lj cer Company: / Ar;^O11
City: ({ S L . State: FL Address: /-77
Zip Code: 3 L/ Fax: - City: /QJ State:
Phone No. Zip Code: 3 Yin/ Fax:
E-Mail: Phone No 72K-170 "S /
Fill in fee simple Title Holder on next page(if different E-Mail
SIffrom the Owner listed above) State or County License// Z-/S-
if
value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION ry _
,
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:
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 thepermit 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 OW ER•Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to o property. A Notice of Commencement must be recorded and posted on the jobsite
before the first i sp ction. If ou intend to obtain financing, consult with n r or an ttorney before
commencingwork r rec n our Notice of Commencement.
Signature
,6Owner/Lessee Agent Signatur o tr ct /L;Et/a/6
older
STATELORIDA STAT F FLORIDA
COUNTY OF COU TY C
The forgoing inst ment was acknowledged before me The for oing instr ment was acknowledged before me
this day of 20 by thi day of / 20by
�-
(Name of per in acknowledging) (Nam4 of person acknowledgin )\
4inature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification /" Personally Known OR Produced Identification
Type of Identifi tion Type of Identific ' �-
n
Produced ed 0. '
' """ KAREN S. NIEL
'I�87" KAREN S. NIELSEN
��1p0. 4B C"I
ca ommission# FF 11 7 r
_ Commission# FF 1 5 7
Commission No. atom ission No. al}y Commission Ex i s
;,� P� y Commission Ex it
June 12, 201 OF F
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R-ev-7772014