HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' `" I Permit Number:
Building Permit Application SEP 0 1201
Planning and Development Services
PEPMITTiNG
Building and Code Regulation Division
St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982Q2/Jc 0
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: 10 l U �- S A1) QP- �(�'��
Legal Description: 5 ;L �� U76ci
Property Tax ID#: 4_�'y 01- PA1 VCU6 (' 6C�` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
PLACE S^Me '(�,,- SAA4LF a Ifu/J �s zS�M LI�cti-
t[ M61ulA A S c141-6 ��,� /�.v S-'E-9 2 wI S'iC.� Nis
CONSTRUCTION INFORMATION:
A
dditionworkto e e orme under this permit:::c ec a appy:
0
Gas Tank E]Gas Piping _Shutters I]Windows/Doors
FlElectric ❑ Plumbing O Sprinklers 11 Generator El Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ��, Utilities: newer E]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ewu% "'C. Name: TJOUN - L
Address: 06 s 7- Company: Coa - _ e- 1,VL
City: n gpe_tzq 14t LL Stater Address: 33 ML 14aAJ&J"y W
Zip Code: �,o Fax: �/ City: 5 State:
Phone No. `nk qp,(- Zip Code: E,`� Fax: x
E-Mail: Phone No. 99A b"72J a'1;54
Fill in fee simple Title Holder on next page(if different E-Mail: `IZ(/vkk.AP-; @ C',)MCA S?. /N61
from the Owner listed above) State or County License: C/•ICy y b 12 IF-
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
commeq=g work or recording our Notice of Comm encem t.
s
Signat e o er/Lessee/Contractor as Agent for Owner Signat f Contra icens o
`2'(C74/V4 I - UOUc/)2� R- (-iL �Ic�aARD. 4 , i�0(1<A r q r
STATE OF FLORIDA STATE OF FL
` OUNTY OFORIDA l lac (F'
COUNTY OF L.k1�JIF,
The forgoing instrurpent w acknowledged before me The forgoing instr ent as acknowledged before me
this day of 20 �by this day of 20 f by
� U
(Name of person acknowledging) (Name of person acknowledging)
0 1 Al �c V__� A O/Ifl �' ljj.'� IL --
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
,
Personally Known OR Produce Identification '✓/ Personally Known OR Produc d Identification
Type of Identification Produced [�•�' Type of Identification Produced I• V'/__
„���,,,
Commission No. ;�"A'`"%�aeaI�KAREN S. NIEL F�t71 'ssion No. � I *"�:�^ (Sgadj2EN S. NIElSEN
ommission# FF 115 37
My Commission Ex ires • _ Commission#FF 115637
o '' My commission'•,+ a+,° ssion
... itine June 12, 2018
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
COMPLETE
INITIALS