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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: k 6o'S -o 1 1 R E C E�V E D Building Permit Application MAR ' 0 2016 Planning and Development Services PERMITTING 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 PERMIT APPLICATION FOR: PROPOSEDINPROVEMENT LOCATICI;N ..r„, k Address: `7jo / 3 9 1 _f Legal Description: Property Tax ID#: AZ2 Goer © l - 00 a Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTIONOF3WORK Wa, ­C-�V J'6 GIS �f'a v+'+ kV,-702,- lye, DG�rcr/'.. y ti d1 CONSTRUCTION (NFORMATIO.N ` r. .. , Additional wor to a performed. 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: Sq. Ft. of First Floor: Cost of Construction:$ A-0 0 JO Utilities: —Sewer _Septic Building Height: OWNER LESSEE CONTRACTOR k 1 _ . !,`'1 v. �f �g ,....! � � '��,. ,�*°z� -' .�°.._�. .'.. ',,.,,.,. ` ,'� �. _ zany ,K1+.. •.AF * - - Name . - Name: o�' f 2Iqlw .r Address: S� ezcl c Company: hin e� a G rod1L� City: o�ye, _ State: Address: h., rAny X27 Zip Code: X33 Fax: City: `l 4�_i State Phone No. Zip Code: 3YYe9 Fax: 77,2- ?9-O k/.9, E-Mail: Phone No 7'u -9ys i”�f z Fill in fee simple Title Holder on next page(if different E-Mail 0�ric 1- / %h w from the Owner listed above) State or County License 2 e,3fI?" 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 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 work or recording our Notice of Commencement. Signature of Owner/Le a/Contract as Agent for Owner Signature of Contractor/License Fielifer STATE OF FLORIDA STATE OF FLORIDA COUNTY OF V.UQC'1C, COUNTY OF 4, _"Q,f . The forgoing instrument w s acknowledged before me Theorgoing instrument wacknowledged before me this Z_day of 2016 by this day of a 20* by PJA Q (Name of person acknowle ing) (Name of person acknowle ing c)�� es—� (Signatur of No ary ublic-State of Florida) (Signature of Notary Public-State of Florida) / Personally Known OR Produced Identification Personally Known OR Produced Identification ✓ Type of Identification of Identification Produced KAREN S. NIELS Rro Iceda� `,oaB AREN S. NIELSEN Commission H FF 115637 Corp mission it FF 115637 Commission No. N e&)y Commission Exp r� IssIon N0. *E My(�8 l)nission Expires '`'" June 12. 2018 °%:�FOFc���� '•�;,�;,;°' June 12, 2018 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 7/2014