HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit ApplicationMAR 2 4 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:
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Address: , ( i2� (3-1Kznn.�� th, 3M(CL
Legal Description: i �L L(3 i
Property Tax ID#: 1409 273 0102, = ' O 0 Lot No.
Site Plan Name: Block NO.;
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR�PTIO�IOFWORK
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Additional work to be performed unclerthis permit-cheCK all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: QTV Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
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OWNER/LESS a� kCONTRA TQR r�a � flszt
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Name L-,-,!Lj wrnno 4pu1) taw 1,3A(z _&_-2 Name: fsGcs�►u
Address: (S"q '_I Qe- )-g: C`'arc��--t)dz— Company: tic_
City: fi-i (prnr State: , Address: .32'71 61 e s4 V G
Zip Code: 'i; Lf tty,(, _ Fax: City: 'F: &e-2z4E5 State: LL
Phone No. Zip Code: LA' lV'2— Fax:�z L1(oL�(o WW
E-Mail: Phone No 'Z"-)"Z -'a i.io
Fill in fee simple Title Holder on next page(if different E-Mail I
from the Owner listed above) State or County License tfeel_
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable
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---Name: ks� —L11 —
ame: -
Address: 'lDS– t:-US C Gca2 Address:
City: fP S State:%1, _ City: State:
Zip: 3q.cjS'Z Phone --7:2-2, q 5"S 2!j 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
improvement��rding
perty. A Notice of Commencement must be recorded and posted on the jobsite
before the fir . If you intend to obtain financing, consult with le or an attorney before
commencingour Notice of Commencement.
Signat a of r/Lessee/Contractor as Agent for Owner Sig^atur
STATE OF FLORIDAI STATE OF FLORIDA ,�I
COUNTY OF Luc,I t', COUNTY OF �}t:
The forgping instrument was acknowledged before me The forgoing instrument wap acknowledged before me
this day of VNAB )k- ,20 by this day of 20_L_� 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 k/
Type of Identif tionn ��� �� T We of Identification
Produced . 1✓ ` AY ifff. A,
KARENAREN S. KIEL ed _"...... -KAREN S. NIELSEN
Commission # FF 115637 a Commission# FF 11563
4=. J1y Commission Ex iCEorn ISSIOn NO. f�cy@31�nmission Expires
Commission No. '-,'•F�o' eal� E ,
June 12, 201 �;;,� „°;.`' 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