HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II
Date: Permit Number:
CE-IIfE
Building Permit Application MAY 16 2016
Planning and Development Services
Building and Code Regulation Division PER:,tITTiNG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucienty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION,', -
Address: a OI d-a r V-400h
Legal Description: -U w d C.
Property Tax ID#: - 0 00 (�, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK 1
CONSTRUCTION_ INFORMATION:
itiona work toe e orme un er t is permit—check a appy:
HVAC 13 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric O Plumbing OSprinklers O Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ `cJ 00 Utilities. Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name X12 orName: 1�,
Address: a�a-off SV,-.eroo(j L�+ CompanyGl
City: (C1- PIS Y c. State:q_t. Address: 01
Zip Code: Fax: City: L State:
Phone No. Zip Code:3IACA`k4 Fax:
E-Mail: Phone No. `)o -
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: RG 1331130
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:
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 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, c ender or an attorney before
commenci rk or recording our Notice of Com enceme .
S
_Sig re Owner/Lessee/Agan Sign racto se tiler
STA F FLO DA STATE FLORID
COON COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
1
this j r day of 20 !�_by this�day of 20 by
In In n I�►n ��F� ►��h►�P` er
(Na a of person acknowledging) (Name of person acknowledging)
10 AA 0
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prod g d Identification Personally Known OR Prodded Ide tification
Type of Identification Produced—R-1, 0./-- Type of Identification Produced PL. a -
Commission No. mission No. , Seal
KA EN S. NIELSE
Commission N FF 1156 7 ~,o;Fa*o�a�., KAREN S. NIELSE
Yission
n wies _� *_ 1, ]
eorr J
�;; June 12, 2018 .,fof"o``� My Commission Expire
Revised 07/15/2014 - June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS