HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: Permit Number: l �0�� Q ��
R EC WED
i JAN 2 8 2016
- - Building Permit Application PERMIT ING
ie Coun
Planning and Development Services i St. LucFL
Building and Code Regulation Division - t
2300 Virginia Avenue,Fort Pierce FL 34982 t
Phone: (772)462-1553 Fa� (772)462-1_578 Commercial 14Li'On'tial
PERMIT APPLICATION FOR:
PRC�POSE® IN'PR®uEMEi�T L" ATI'C3N:
Address: /g �1 � c .
Legal D scripti n: ��/ ��!� �C.�'✓
ol � W10 1 /d --i®r--- e
Property Tax ID#: J y�d `� ^dam Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR#IPT'1®N (3F V1/ORK:
k�- ✓ 'l 'rZi�
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C®`IS�TR'UCTION"INEO.R ATIO N . . ..:.
>r �� � ._ ,.
Additional work to be performed under this permit c ec all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof.
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OGWNERfLESS4EE � C®�NTRAC1'OR: '`
3
Name Name:
07
Address- C Company: ,Bl/
City: 46 W�.- ' State•%4 Addres
Zip Code: k d Fax: City: State
Phone No. / 771- SSS- 7& Zip Code: i? =:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SLIPPLEMEN � L CONST• 11CTtDN L:IE� LAW I•N'F0'RMATI`ON:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: v State: City: State:
Zip: Phone Zip: Ph ne:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: [A
Address: Address:
City: City: V 11
Zip: Phone: Zip: Phonej
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.,makbs-4)o rePr"esentation that'is grail mg a*pefmitwill authorize the.permit holoeFtto build&e`�utijecfi�structure
which is in conflict with any^ap'§licabJ6Home',-OWners Association•rules; bylawsor arrd tovemidtath-at may�estnctbr prohibit such
structure. Please consu t with your,H'ome Owners Association and review your deedTor any.restsictions which may apply.
In consideration of the'granjing o`f this'requested permit, I'do tie{ey agree�tat'Iwill;in all reypects,:perYorm'the work
in accordance with`.the approved plari's;,the Flor'da.Buildtng'Codesd'StLucie Count Am, ndments'.':'
The following building permit applications are exempt from undergp'riga-full con'turreJicy-review:roop)a lditions,
accessory structures,swimming pools,fences,walls,signs,'screen'roms 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
commgaQK work rdi our Notice of Commen
ZTE
e of Own / essee/ nt nature of Co tra for/Lic a der
OPT', ° ID �,. S ► E OF' ORI A
COUNTY OF ,fC COUNTY OF Z. C!, ..
The forgpIing instrument was acknowledged before me The fo ing instrument was acknow)edged before me
thisday of if 20_U�by this day of I20 by
1 errs W��P►/ AIKQer
(Name of person a owlg' ) (Name of person ackn ledging
r ,
(Si at a ofotary Pu/blic-'State of Florida) (Signature of Ndtary Pyr I' 'Stat,4f Florida)
Personally Known / OR Produced Identification Personally Known v Produced Identification
Type of Identificationa of Identification ,•Y„RY'i''�
Produced
KAREN��S. NIELSEN P ducedMl
Commission k FF 1156 7 mission Expire 'o o.�� - FMyCoCommission No:' 1 = (SIS: Cmission No `J, .= u,,ai���,;. �..." J'unE 12 2018
REVIEWS FRONT ZONING: -X-SUPERVISOR PLANS VEGETATION' SIEA TURTL'EF,` MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW' REVfEW ' REVIEW
DATE
RECEIVED
`DATE
COMPLETED -
ev.