HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: In 'I l Permit Number:
"'1 I _, Yrs-E L�i
OCT 1 1
Building Permit Application 2016
Planning and Development Services PERi:/1I77ING
Building and Code Regulation Division St. Lucie County, i=L
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Nllk
WA
Wq
It
PRPOSf D IN PR01/EM
a ..,
Address: 6AV 66CfJr
Legal Description:
Property Tax ID#:q00 93a c' Id, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP710NyOF WORK _ f r
0 r Y` T"a3
CO,NSTRl1CTI0N INFORMATION f aw,
Additional work to be pe orme un er this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ _Jg � Utilities: —Sewer —Septic Building Height:
OWNER%LESSEE CONTRACTOR131 .,.. °.
Name Name:G�ilf
Address: 6402 -50✓yer OO✓ Company: FP r L
City:1�1 Y""r X 4 /'/ -:?45 QZ Stater Addre7S iVV_5)_ Af Z 23
Zip Code: Fax: City:,Pr 'f, Lt[ i State:
Phone Nc-72;�, 83 Y— 32S/ Zip Code: 5ti%� Fax:
E-Mail: Phone NoC27 Z)
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License o`1
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S
SUPPLEMENTAL CONSTRUCI"IONLI,EN LAW INFORIVlATION ` {k y.
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 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 o otice of Commencement.
qSi �ture of Owner/ ssee/Contractor as Agent for Owner =tb\Q't'ractor/LichI:1se HolderSTATE OF FLORIDA ,�1 FLORIDA I '
COUNTY OFA L )o,i F, COUNTY OF L�)c'I
The for
instr ;� tPywas acknowledged before me The forgoing instr t was acknowledged before me
this day of 20 Ito by this day of 20110 by
(Name of pers n acknowled ' g) (Name of person acknowledgin
e9--�
(Signature of Notary Public-State of Florida ) / (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification ✓
Type of Ident' at' g NIELSE a of Identifi atio
Produced �-' "�., KAREN �Pr uced ��'L' ;`;�a� KAREN S. NIELS
mission# FF 1156 ,� ._
Com it s r Z ;p Commission # FF 11 6
*` M Commission Exp Sea Commission Exp r
Commission No. F�o�; (Seat)iune 12, 2018 Co mission No. �';;��F� �June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014