HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //ff��,, 1�
Date: �� o/� Permit Number: I U 1- 00,1)4 0
RECEIVED
' : I FEB 18 2016
� } Building Permit Application pEW01TTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentialy
PER ITAPPLICATION FOR: S em
PROP(•,101 INPR§ffl%MENT LC•7CATIII ;
Address: 3
Legal Description: -
Property Tax ID#: l t- --� �/! dG0 dC>!�� d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE�iTAILED 100 al
ti
FEWN
WO X
C® 5TR+UCTI• N IN:FOR1111AT(ON:
Aaditional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters. _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof.
Total Sq. Ft of Construction: s Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
. O.U,1/aNER/LE�SS,�E;: �CO,N�RAC•�TO�,R: '
Name 6 ,Y2d$ Name: a., rl,"� Dp
Address:. -;L 'Iv !/ Company: ✓ 1G, .�2�oGYp(�
City: o" Stat;V. Address:
,U� /_f
Zip Code: S Fax: City: /l�'/��¢r State: -�_/
Phone No. 771- 9 if LZ a Zip Code: 3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail 16w 4. ,4oi'-e 61ivV
from the Owner listed above) State or County License cg, !._�1 S—D/
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPL.EMENTAI.C®NS�T �UCTI'ON L EN lAW IN 1ORMATIQN:
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 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 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 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 woA or recording our Notice of Commencement.
SignaturOF
r/ ssee/Agent Signature /'o
r/Lic nse Holder
STATEIDA STATE ODA
COU COUNTY
Thefo oing instru t was acknowledge .before me The fo oing instru s acknowledged before me
this_M day of 20p by this day of 20Lpby
KVA-�n- L-6 k A U, Ergeb
(Name of person ac wledg ng) (Name of person nowledging)
4,4
VAA a, 0 a,-,
U—�
(Signature of No ary Pu lic-State of Florida) (Signature of Notary)3,bblic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification f Identification
Produced `° KAREN S. NIELS�I od ced . /- y4�, 1 -*:
,,,,,,,, _ `���pAY nyel�� I(A R E N S. N I E L S E N
"Y'° mmission k FF 115637
=� Commission# FF 116 637
}- My Commission Expires
Commission No.i)- "':9, Peary Commission Ex ir@bm ission No. „�`'� (Seaye 12, 2018
June 12, 201 "
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DATE
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