HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I c) OV
R E Com °
Building Permit Application APR 2 12016
Planning and Development Services PER[.1IITTING
Building and Code Regulation Division St. Lucie Count., FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR 1ROSED I,NRRO�/EMENT LOCATI .N:
Address: l IJ 4-,e_,tm L.�� d�'l G `✓����p
Legal Description:
Property Tax ID#: 4�/o)S 70 ) L,)( l000 `"� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front ,Back: Right Side: Left Side:
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C®NST'RIJCTIQ� I�N'F®RIUTATI:QN:
Additional work to be pertormed under this permit—check.a that appy:
_Mechanical _Gas Tank _Gas Piping hutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: qr Sq. Ft. of First Floor:
Cost of Construction: $ 9 Utilities: —Sewer —Septic Building Height:
OUVN'f R/LE=-S�SEE: CO.NT'RAC1'OR;:
Name P'W aJ_ :h21 ><ti Name: C le .0.c.e_ ,SA&
Address: 01/1 Lir e-z' 4/1 Company: o beA- ,4141
City: ®B-/An Gt 1� State:_� Address: 76 36 S cA S lf�r
Zip Code: 0 Fax: City: P.5 e- State:):�'t—
Phone No. Zip Code: Fax: -77X 6.2/
E-Mail: Phone No 772— 7 — G 2A
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License (f&
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU . PLEi\/IENTA�C®NSTRIJCTI®N LIEN LAU1/ I `?FOR±MAI"IN:
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 r our Notice of Commencement.
gnature of Owner/Lessee/Contractor as Agent for Owner Si re of Contractor/License,Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF LU CI F COUNTY OF .I
The forgoing instru ent was acknowledged before me The forgoing instrullent was acknowledged before me
this�_2ZL day of 20j_� by this day of 20_t� by
_Yo! kL
( a e 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 Ident' icfi�in rsonally Known 0 tion ✓
Type of Iden ' on
``��tiFAY p�,�.
{<AREN S. NIELSEN pe of Identificat' _o ItAREN S. NIELSE
Produced _' "pY _
'O ommission it FF 115637 oduced �� /�•� °• +: Commis
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- My Commission Expires 'srF P •` My Commission Ex15637
2018 ssi pire
Commission No. / °F Seal yne 1 2. mmission No. ne 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4