HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: Permit Number:
t001�r
Building Permit Application JU�3 2 1 9g16
Planning and Development Services PERMITT NG
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: `�'�C CnL
PROPOSED NP'R(JUEMENT LQCATIO'N
Address: a. 777- LuL�j Le, e, V-uy-1 `1�;eY, -�5L 9R )
Legal Description:
Property Tax ID#: 3 0 - �'s b a. b b It - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRI'PT ON ® ORK;
CQNSTRUCTIO INFO' �MATI'ON•
Additional work to be performed under this permit-check all that app y.
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
ectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: V 5DU• e>3 Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
01N'NER LS�SEE• CONTRACTOR:
Name Name:
Address: Kn )- LkA`y Lc, _ Company: -
City: State: Address: LAVC
Zip Code:" '59491 Fax: City: State: -
Phone No. 7 7�- 33a- 133 — Zip Code: Fax:
E-Mail:yi bkc-Q c't-"a i • Co Phone No
Fill in fee simple Title Holder on next page(if different E-Mail 'o-C�LSC
from the Owner listed above) ate County License ,00
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLENIRSI AL C®'NSTRIJCTION' LIEN LAW IiNINS r MATION,:
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 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, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Q�'?Z '4� Z"� - qwe'�11115�'
Signatu of Owner/Less ee/Contractor.as Agent for Owner Signature Co tractor/License Holder. .
ST OF FLORI STAT F FLORIDA
CO TY OF i ldr, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20�Q by this day of 20 ,0 by
\ M�to
(N a of person acknowledging) (Nam f person acknowledging)
(Signa ure of Notary Pub ic-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 -- �.��. Produced
KAREN��t4°nnT.miC�Yee. `��1�l PHY P
B
NIELSEN mmission No. - �__ Co, ��S.�j
Commission No. c(�aC�isSniSsp nF 71563 F m M OR,m on S k F El EN
F
637
June Expires _'�a� J S'�n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE E_
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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