Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: („n CINE® JAN 2 5 2016 Building Permit Application PEHiMITTING Planning and Development Services ;.ucie 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: � E PROPOSED I�N�PROVE EN L©CATION: Address: / © �' a e Legal Description: � '�� �`0 G e9//0 (f/(r' V,1!` (,� F} I�-7 � (�� -e-_3 � 7 7 5 Property Tax ID#: 3 ��O 3� CD©� 0 Lot No. 2�-- Site Plan Name: �d Z) 3 3 ��' ��1 (z�S-ems VL �^/I S� �- -rrt�,�r��l� Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED D-E�SCRI'PT!®N OF WOR4K CONSTR�UCTt (NFO�R�IVIATI®'N: Additional work to be perrormed. under tis permit-c ec all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric lumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ �i7 Utilities: —Sewer _Septic Building Height: (�3WN'ER/LESSEE: � CO;NTRACT®'R: Name �j'�Mt� eti� Name: O L vwo Address:_SgyC) vL Company, �v~n0J), �2ILPAd,- City: S State: Address:,/'? Zip Code: 3 T 7 C� Fax: City: rcc State:-K—� Phone No. 626 Zip Code: Z YC/S1-( Fax: // E-Mail: Phone No �l 2 ??0 /l�7 Fill in fee simple Title Holder on next page (if different E-Mail 6(4 orn P's e) Nz�z%c 99AO j, CC)Al from the Owner listed above) State or County License 06 �/Sr If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INF©RMATION: 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 structurj,s ming pools,fences,walls,signs,screen rooms and accessory uses another no -residential use WARNING TO;p ER/Your allure to Record a Notice of Commencement m esult in r paying twice for improvemen�ts t yourty. A Notice,of Commencement must be r rded a osted on the jobsite before the/first ' spectou int d to obtain financing, consult w' ender a a ey before commnci'nrk or r r Notice of Commencement. r I� Signatu eldf Owner/Lessee/Contractor as Agent for Owner Signat e f C ractor/License Holder ' STATE OF FLORIDA STA OF FLORIDA COUNTY OFIF. CO TY OF i AV/ The forgoing instr ent was acknowledged before me The forgoing instr ent was acknowledged before me this day of 20�by this�day of " 201(7 by (Name of person acknowledging) (Name of person acknowledging) (Signature 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 lclentificAiim pe of Identificatio Produced o""`ra'"!. (AREN S. NIELSEN roduced �p*�"8�,, KAREN S. NIELSEN ;r n :' Commissioo# FF 11563 Commission FF 115637 mmission Expire Commission No. g6ag miiExpires sson xpres ommission No. �F o;•'� Y PP • P. � �' ��Ya�Gne 12, 201 B June 1 2, 201 8 +� REVIEWS FRONT ZONING . SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/201.4