HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
«� 9Y '.7 �r!%� € '� .•� Yom.,, �:I. yrF�h i., �' '
SEP 1 2016
Building Permit Application PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRaPOSED INPRQVfMENT 0CATIaN K. .-.-
/�
Address:
Legal Description:
Property Tax ID#: � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION:OF WORK:
C % ,RUCTION IN'FORNiATIQN
Additional work to be pertormed under this permit—check all at appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _LX0of itch
Total Sq. Ft of Construction:: )'U U a Sq. Ft. of First Floor:
Cost of Construction. $ ( U ��U Utilities: —Sewer _Septic Building Height: �y
01NNER%LESSEE CONTRACTOR.;
Name Name..
Address: ;� �.I�D Company: -lolb
City: � �r<l�'j� �� -�>l �� State:� Address: _
Zip Code: Fax: City: /� 'e State:
Phone No.2)y_- Cd I'O Zip Code: Fax:
E-Mail: Phone No > — Yo —d >
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County LicenseCGG / ?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
p
SUPPLENiENTL CONSTRUCTION110, LAW INFORMATION
DESIGNER/ENGINEER: y _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 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
commencinp,work or recording our Notice of Commencement.
SignarFFLORIDA
/Lessee/Contractor as Agent for Owner Signature of C ense Holder
STASTATE OF FL IDACOUA JJ(�(1,(F COUNTY OF
The forgoing instruiprient s acknowledged before me The for oing instru entacknowledged before me
Zdis day of 20 LO bythis day of 20_1� by
V�pn��j P (PLO FE+�\
(Name of person ac owle ging) (Name of person ackn wledging)
AA �. d c- 9 , Ll-
(Signature of Notary ublic-State of Florida) (Signatu a of Notary Public-State of Florida)
Personally Known-OR Produced Identification Personally Known V",X OR Produced Identification
Type of Identification Type of Identification
Produceduced
,,•�'�r.,,, KAREN S. NIELSE KAREN S. NI SEN
Commi
'd Co mission# FF 115 3 .= sion#FF 115637
Commission NO, *aSeM4 Commission Expir O mISSIOn NO. 'P,.? h0tB mission Expires
,•.', orn��,` '°'�°nen;,
June 12, 2018 June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014