HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 9 j
Date: Permit Number: 4 `f—1
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Building Permit Application APR 2 5 2010
Planning and Development Services PERIMT-mNG
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: P r
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PF�OPt?SED IMPR01iEMEVT�LOCATIC, z, d'41M
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Address: 32-00 s J 22 v
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Legal Description: -.e_544.01ceY/ � du/0 o
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Property Tax ID#: ODo,b/ Lot No.
Site Plan Name: At,Alco Block No.
Project Name: /Li/l/c
Setbacks Front Back: Right Side: Left Side:
DETAILED QESCRIPTIONOOF WORK
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�CflNSTRUCTION
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Additional work to be e Orme tinder this permit-check all appy:
F]HVAC Gas Tank E]Gas Piping M Shutters Q Windows/Doors
Electric ❑Plumbing Sprinklers 11 Generator E] Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ J b O Utilities: _Sewer 0 Septic Building Height:
Q1t�1NER/LSEEr -`_. c ¢ .. CQNTACTC}R ,_: . _ _ k ._.._ ..
Name ell aA IiiT Name: d L
Address: �Tj_00 /cu/�vL�da�S T,?il✓1 zo Company: �/ 7zxa s . C
City: r,pwe Ac Stater/ Address: A,1�4&
Zip Code:_3 4/�5/ Fax: City: State:
Phone No. 53 Z Y6 r Zip Code: " / Fax:
E-Mail: Phone No. 1- 7�S!
Fill in fee simple Title Holder on next page(if different E-Mail: !fie ea&k ,epi
from the Owner listed above) State or Count License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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PLEMEtTAL CQNSTRUL'T13DNCI (V LAUtI INF F
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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:
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 thepermit 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 O R:Your failure to Record a Notice of Commencement ma sult in your paying twice for
improvement 0 our property.A Notice of Commencement must be re r ed and posted on the jobsite
before the f' st i spection. If you intend to obtain financing, consult wi I der or an attorney before
commend w rk or cordi our Notice of Commencement.
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_Signature of Owner/ ess gent Signature of ontractor/L' ense older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `�)(',1�, COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 20 l�.by this day of 20 by
N) C-J-1 t . 71jm'd 0.�Aow
(Name of person acknowledging) (Name of person ac nowledgin
(Signature of Notary Public-State of Florida) (Signature of Notary Pub ic-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Identification ProducedT_
KAREN S. NIELSE
ommission# FF 1 Yp��.,, F S. NIELSEN
Commission No. 'Nab nm sion No. \ �
ar My Commission E plres Clomm�s ion# FF 115637
._
June 12. 2018 - = My Commission Expires
Julie i 2. 2 13
o�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS