HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ii 11
Date: , Permit Number: I I �� D(OtO IQ
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._.._w. Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Y
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: a K �✓
PROP SED 1NPROEMENT LOCATION: M`van
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Address: 2 f 7Z' 7 C I`D q V 01 S A*
Legal Description:
Property Tax ID#: o Z o tlrr oo a 6 Lot No.
Site Plan Name: Block No.
Project Name: ! y6 yo
Setbacks Front Back: Right Side: Left Side:
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NSIJC�t t TION N OR`MATIO
Additionalwork to be pertormed under 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: $ 2 3 �y Utilities: —Sewer —Septic Building Height:
:Name. �t'c%r�;:.� /✓ �a..rl �o•►�ya.gP /elfn Name*::'
Address: PYL2./ Aµ WCompany: JC MA.
City: /�u..�h f State: Address: VIfSS r✓.,_..�".: ;/�/
Zip Code: �r 2-T1F 'Fax: City: ti��►��«-� State:
Phone No. Zip Code: 3 3 d Fax: O r6�7 �l60
E-Mail: Phone No J19 fe 8 -X 3 2.4 el
Fill in fee simple Title Holder on next page (if different E-Mail %tea -mom 11,-o I ec, e
from the Owner listed above) State or County License i"/? C / 2 ro 2 fd
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRIJCTkON LIEN LA1N IkN'FORIVI/�TI®N: WIN"
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 re(:�Q rding your Notice of Commencement.
Signature of.Owner/Les /Contractor as Agent for Owner Signature of C trac or/License Holder
STATE OF FLORIDA; STATE OF FLORIDA I'
COUNTY OF COUNTY OF LIE
The forgoing instr a ent was acknowledged before me The fing instr ! nt as acknowledged before me
this�day of 20�gby thisday of 20_1p by
E u w t°i I �—,I Mn �� we'9 I f-��mf-'
(Name of person acknowledging) (Name of person acknowledgingA?,A
)
(Signature of Notary Public-state of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification r Personally Known OR Produced Identification f
Type of IdentifigXion Type of Identific ion
Produced r L ced
KAREN S. NIELSE / KAREN S. NIELSE
Commission No. lel' I ° $ ]»mission N FF 115 Seo ission No. I �0 .+`�`, �`�'�( mission# FF 115 3
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My Commission Expi es ;; dc My Commission Expi e
June 12, 2018 June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014