HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE iiINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.,11,00_ ` 1`1 —
BuRding Permit Application MAR 0 9 2016
Planning and Development services PERT f1TTING
Building and Code Regulation Division St.Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 f
Phone:(772)452-1553 Fax: (772)462-1578 Commercial Residential v'
PERMIT APPLICA 1 ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATION:
Address: �a,S�SS�G3C T>,/L t7s�C rL 3q.Fyd
Legal Description:__r 2,FTdN f9&4Z^ (.4f!t1r V 1QW44T-LQ7- --32 -
Property Tax ID#: 4632. ?467 Qb d ctGi Lot No. 325"
Site Plan name: Block No.
Project blame:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
l/YS?"igG G �t/est.7owS �-!v� ,r,�es'o �acaRS
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CONSTRUCTION INFORMATION:
Additional work to be—ne-rtormedunder this permit-check a �apy:
®HVACGas Tank Gas Piping tters Windows Doors
Electric ❑Plumbing Sprinklers 0 Generator o Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ I � Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name � Cy Name: 7A' AM t.cfte a AtyM
Address: 70 2- _T e, lc6 rr Company:
City: State:P(, Address:_3 S,+-^er f =�
Zip Code:_,-?q!?Xo Fax:172 City: �.ei c'T" L.t�cit State:.I-L.
Phone No. Zip Code: Fax:"772 33G-S 329
E-Mail: Phone No ?2� �. 5. 11 -21111
Fill in fee simple Title Holder on next page(if different E-Mail: ,( �Lyrj ,L1,41 L C d M
from the Owner listed above) State or County License:_2447_'2
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 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 work or recorcift your Notice of Commencement.
Sigature of Owner/ ent/Lessee S' nature of Contra&or/License Holder
STATE OF FLORIDASTATE OF FLORIDApp
COUNTY OF ��.-`- COUNTY OF
Thergoing instrument wa acknowledged before me The f Ting instrument w s acknowledged before me
this day of 20_Wby this day of ffin20_Jkby
y7v]' Aa� l ,F �1�� i� 1�1 t�1 t� i�P �n'1J)( ame of person acknowledging) (Name of person acknowledgingidlo
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)
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(Signa ure of otary Public-State of Florida) / (Signature of Notary Public-State of Florida)
Personally Known OR Prod ed Identification Personally Known OR Produ-cadIdentification
Type of Identification Produced i n.L. Type of Identification Produced
• _ u N S. NIELSE
v„n,��; iaA
AREN
Commission No. S NIE A.gmm ion No. — ,.'gyp=^�a;{Sea
KAREN! C mmission # FF 115147
Commission ;I FF 115637 -
s My Commission Epi
+= n E res 201 8
^ 2, 2018 ^�
June 1
Revised 07/15/2014 of
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS