HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a� 1(D Permit Number:
01
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•� N �• Building Permit Application
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Planning and Development Services PES 1j1l' Tiik9C
Building and Code Regulation Division St. Lucie Coinly) FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: . e
PROP VIM MY MOA
ION:
Address: sols-
Legal Description: UleO To C -Afl g,tom, &—F_4vl,:c-
k,'4t -,tSlet-J /cdhI- G "a �KP,N d404Ce,ASIOus �
PropertyTax ID#:j?5zz_ r��, 'r���Y�'/�/��'/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
JERENTEELIEND QESCR�IPTIO WOR+K:
af-W C 1 C4vL'c 5'0 Crs /) o -,, (eco-�t
®�`��►4� � Aliily S Y1u-t .��"FS Cc�� �o�� (�l '1Chc._ S � ti �, J"
CONSTRUCTION I I.Fi(.9,
Add
itiona woe to a pe ormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric lumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First.Floor:
Cost of Construction:$1,(�� Utilities: —Sewer —Septic Building Height:
OW ER LESSEE: CO TR CTOR:
Name e0i,14TM UC /m cy-V S Name: : .
Address: 11.'l 611,o -1, .4)'W_ C Company:
City: �O�} .� l PCC—. State: L Address: / 7 z f JU C-tu"y�
Zip Code: 3Y0,'0,' Vet Fax: City: es( State:•'(l
Phone No. Zip Code: 3y Y Fax:
E-Mail: Phone No "'2? Z 3-70
Fill in fee simple Title Holder on next page(if different E-Mail -4v^v°D /0 A2, �'ho/
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
mal PPLEMEN L CO'NSTRtJCTI®N LIEN L.AW I°NFORIMATION:
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 po ,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNE f failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo perty. A Notice of Commencement must be recorde nd posted on the jobsite
before the first ins n. If you intend to obtain financing, consult with lenr or 4 attorney before
commencing wor o ecordink4our NAice of Commencement.
L11 X///z//4�
Signature caner/Lessee/ to as Agent for Owner Signature �FLORI
ctor/ iEense Holder
STATE F FLORIDA STATE OD
COUNTY OF COUNTY OF'
F
The forging instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this off'I day of 20 by this day of 20 by
P.V/ Al�
(Name of person ackno edging (Name of person acknowled ng)
c9
(Signature o otary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced -"-a _ — - Produced
KAREN S. NIELSEN ��`'ovPu'- KAREN S. NIELSEN
�.o>PY'4B�`!� `' ^�4 e`er'_ CommA � # FF 11'5637
,_ C ssion# FF 115637 . OmmISSIOn NO. " *: 1g�81)
Commission No. - iA�y �mmission Expires � My Commission Expires
June 12, 2018 ''o;�ori�°:' June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
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