HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:� � '�� Permit Number:
RECEIVED
Building Permit Application DEC 3 0 2015
Planning and Development Services PERIAITTING
Building and Code Regulation Division St. Lucie county,FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line W1 NOW S
PR®P;OSE® IIVI;PR®VEMENT L®CAl'ION: ,p'
Address: JTy/,� r�assia ,0i l'p-e / i�°i'-e 3 T7 80,;z-
Legal Description:. 2;7e.-1127,7 'we C5 /6 les + (--A' 6 - 131, 7 3
oh� /t/ /d /rpt aZ3 6,iow 3Y///A/) COX XZ5'7- 21Qa6 o*a 33) ' las)
Property Tax ID#: -3.N 0 X ' 6 10 Q 105- - 069 Lot No. "Z112-
Site Plan Name: Block No. '7.3
Project Name:
Setbacks Front Back: Right Side: Left Side:
D�°E7'�41 �E® DTE�S�R+I,PTI"0'N t�F t'N'0'R�K:
WelaATGC e_r)5rIH9 wif'tdUwS wvNC cc. All
r�Ile,' r"na/e han -I'VI'vo 04::� }- �1•04169 ws/, Ens 1,14//
/Iew rim c/omc-1 relhs Imo, // eA-I's �i'tiy sl sil7-.e,�,s .
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C®,NSTR�l1CT�10�N IN'F®R�IVIP►1"ION: -..
Additional work toe e orme under tispermit-'checka appy:
1]HVAC Ei Gas Tank Gas Piping In Shutters Windows/Doors
Electric ❑ Plumbing' Sprinklers Generator _Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 5!g00, Utilities: —Sewer Septic Building Height:
CIUVNER%LESSEE ' CONTRAE:T®R
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Name 6'liaec o.-1 e( Name: /A
Address: %,o/S �assia �ri'[iae Company: c�i'�ps� Ile eAA G�tis� ..t
City: `� 1 ii��o� State: /� Address: i-W
Zip Code: 3 y`�3�2: ;Fax: City: /�i�. /-� '.,c.r Stater
Phone No. 77GZ y6S _ G877 Zip Code: Y/9 `l 9 Fax:
E-Mail: ----- Phone No. 7.702 - A/6 --/3 07
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Ci (7'G - /.S/Fell�-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
"830.01ME11/1ENTAL CONS70k I'IION l.l,EN L��W IN;F®RIMRIVI/�1"f®N:
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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 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.]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
commencing work or recording our Noti a of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor License Noffer
STATE OF FLORID J STATE OF FLORIDA // . ,,
COUNTY OF LUctE COUNTY OF Z.(J !E
The f oing inst ument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of20by
(Name of person know[ed 'ng) (Name of person ac nowfe14
d
%
(Signature of Notary Public-State of Florida) (Sig ature o Nota.,ry/Public-State of Florida)
Personally Known.-IZ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced ®, i2o#.ld ntification Produced
KAREN S. NIELSEN
Commission No. =` Commission# F CoMrsi7ssi n No.r
MyCommissior Expires "pVPye�. KAREN S. NIELS
June 12, O18 °`
_ Commission# FF 11 37
cmc My Commission Expi s
Revised 07/15/2014 %:FOFI°a�' June 12, 2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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