HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 1 1 Permit Number:
Building Permit Application NOV 201
Planning and Development Services
Building and Code Regulation Division 5tPi=Fls9ITTi NG. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
x u.'ws .!rfiPyl r.;sawn*' pK x, tussa.,u ...o-.K ¢. r^�: r `] ftj "
�PROPC)SED INPROIEtUIENTLp:CATIC?N§ F ' a
�. . -2AIM .N; _: ,
Address: h,/zzz pxp-e��
Legal Description: Z-1► &9-6 - A" ioa
Property Tax ID#: -w4a,,;2 f iy,01t0 Lot No.
Site Plan Name: Block No.
Project Name: ' % Ddb
Setbacks Front Back: Right Side: Left Side:
�DETAIWMA,EDDESCR�IPI®N
, •` tea= 2a -g4 r, s"t* Int '14z°j_ `fif- "s: #! ` s 1 �'
s
CQIUSTRIJN�INQ�RMA►T ® .
Additional work to be pertormed un er t is—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: �v
Cost of Construction: $ r/`t, y o L�o Utilities: —Sewer _Septic Building Height:
®1lti SE,131,'t 4 4NTRACTOR: yy '; � `
Name Name:
Address!."
ddressCompany:,. Ali 0 %Q-RttlAr1K1
City: _" i State:_ Address:
CONSTRUCTION, LLC
Zip Code: Fax: City: Ft. Pierce_'FI 34947 State:
Phone No. Zip Code: /J Fax:
E-Ma* - ` -(, Phone No7 'y ,,, ))
Fill in fee simple Title Holder on next page (if different E-Mail f�NDX6,5 GONX7 WZr-, �
from the Owner listed above) State or County Licen4C5 �o?702,2�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
StJ�PPLEtI/lfN1`AIC®NSTR,I�.�TI®'N LIEN L.AW UN�F4RNI�►TIOtW:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPAN _Not Applicable
Name: Name:
Address: Address:
City: State: City: State
Zip: ;LlVhbne Zip: He:
FEE SIMPLE TL H LDER: _Not Applicable BONDING COMPANY- Not Applicable
Name: 1#4 Name:
Address- Address:
City: City:
Zip: Phone: Zip: hone:
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 in ection. If you intend to obtain financing, consult wi lender or an attorney before
commer)cing wo#or recordin our Commencement.
1
Sig to of Owner/ ssee/Contractor as gent for Owner Si a re o C ntractor/LiceY-4o-I
der
STA OF FLORIDA ST E OF FLORIDA
CO TY OF COUNTY OF
The forgoing instrum nt was acknowledged before me The forgoing instrum nt was acknowledged before me
this_�_day of 20-ILO by this_L day of 20JIA by
U no O�oos-6nk unn 0,1M4n, ,,V
(Name of p rson acknowledging) (Name of pe son acknowledgi )
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known t' ication
Type of Identification Identific tion '��'"" °�; KA
yp ,• •, KAREN S. NIEL �+ _ REN S,
Produced l i. s• Commission.#NIELSEN
Commission k FF 1 er�jdu d issi
_• •_ •.��o�,�o�'.�� y Commis 15637
a,�� My Commission Expires 10 s'On Expires
Commission No. „ ^Y,;, f;�( al) June 12. 201 BCom sion No. @el 2018
ro
M 1
REVIEWS FRONT- ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4