HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T� I � 2 Permit Number: I 4- �lstD
•
Building Permit Application APR 2 5 20%
Planning and Development Services PERWTrING
Building and Code Regulation Division St. LucieCou , FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-
1578 Commercial Residential 8
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 1� fiiclAl_
PROPOSED IMPROVEMENT LOCATION: �J
Address: _'70 /lei i74. S 31-VO
Legal Description: J-kc oa �c> CwG C`
NEDrL s n,6v60 sire- a. TAk. Jalu
Property Tax ID#: '-��ra(7 0`���y) �Li-5 l wo G Lot No.
Site Plan Name: Block No.
Project Name: 't°•
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ZONE
CONSTRUCTION INFORMATION:
Adchti3rhal work to be nertormed under tispermit-check all appy:
HVAC Gas Tank ❑Gas PipingOGenerator
Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Y_ / Utilities: _Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name %t6P-1' A v Name: ` IC 0-4 CzGI
Address: 19170 Ak-f7t,cS �LO Company: :222,-MA:-J,N 4& 1n1
City: JENL_N 8,!,14 Stater Address: m_; I,& T2cv+1e ru
Zip Code: 3 q c'S'1 Fax: City: `i�`S'�, State:
Phone No. rpp, G 3) Zip Code: e3`'c 0Fax: �
E-Mail: SAN5H,4wo C0LtlZ o Cy 1 Phone No. 9911 1 8 qF2 02��
Fill in fee simple Title Holder on next page(if different E-Mail: fA VbL.IC ��
from the Owner listed above) State or County License: edI;,pLlp(,25
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:
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
commWcing work or recording our Notice of Commenceme
(//,*/— '�')Z��_ � ell",(1-17 s
_Sig re o Owner/Lessee gen7IC�I �� J�ii�j Signat r of Contractor/License Holder
STATE OF FLORIDA 1 '` II`` STATE OF FLORIDA
COUNTY OF u�(�,1 F_ COUNTY OF Li tc,
The forgoing instru ent was acknowledged before me The forgoing instru ent was acknowledged before me
this��day of 20 (�by this day of 20 l by
v8LVnd
(Name of person acknowledging) (Name of person acknowledgin
r
---'-O,A- S�
6ajQ
�0> J—�
------------
(Signat re of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Prod ced Identification
Type of Identification Produced. 1'�.L Type of Identification ProducedL L-
Commission No. `J mission No. J mar E fV S. N I E L S E N
REN S. NIELSEi
-�� BSC"-
Commission# FF i 156" 7 �� _ Commission k FF 115637
!_ -R
=a �.
My Commission Expires
";epFF.�a A�ne 2018 °;;;;:� June 12, 2018
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS