HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J h
Date: ✓/ q 147/ Permit Number:
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Building Fora€t Application MAY 0 9 q
Planning and DeVelopmentServices _ PERNIF TI1'JC
Building and Code Regulation Division 5t. Lucie C/ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982 _ /
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential vvv
PERMIT APPLICATION FOR:105
VS. V11
- --- -
Address: I 1?0C56 U--+ P 4 �r- 3 [,r Ll 'I_ .�
Legal Description:
Property Tax ID#: 2, 0 or Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front . Back: Right Side: Left Side:
NO-_111-07
G'
Additional Work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas'P'iping _Shutters _Windows/Doors
Electric V Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic building Height:
U� [ER'�LE�SS E,Er -~
Name iJ• Name: t✓�n �D ) — OZ.�,ti"S�e✓1
Address: i 6 SO 6'r-e- ,/4,-,4l•. YA Company: 0'n Jd
City: State:F Address-: S'
Zip Code: q 1 IL1"7 Fax: City: 0, R-cry Stater
Phone No47-7 S0 1 - 5 1 �J Zip Code: 3���� Fax:
E-Mail: Phone Nor-77 1.1 - 1.761 - 367 3
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License �_S X10.4
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
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: j
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 Courity 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 Saying 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 w rk or recording our NCtj4 NCof Commencement.
i
Signature of Owner/Agent/LesseeTContractor nature of Contractor/License H>p,"(
STATE OF FLORID STATE OF FLORIDA
COUNTY OF , Lyoie COUNTY OF { /
The fo oing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of 20y this day of d 20 ( by
cjky-1
i
(Name of person kknowledginM (Name of person ackn wledgin )
(Signature of Notary.Public- to e of Florida ) (Signature of Notary ub ic. S ate of Florida )
Personally Known_ OR Produced Identification Personally Known OR Produced Identification
Type of Identif ion e of Iden ' tion
'Produced ,�`aQY^aeo KAREN S. NIELSEN P duced
Commission 8 FF 11563
` ° o' My Commission Expires _
'00,
I<AREN S. NIEL E
Commission No. ;° �� mmission No, s S �,mission N FF 11 5 7
(SP-one 12, 2018
v y 4rZ My Commission Ex it s
EO F° June 12,-201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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,DATE -
RECEIVED
DATE
COMPLETED
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