HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `1' oc1' Permit Number: Q
0
Building Permit Application NOV 2 ! 201%
Planning and Development Services PEP[f i i l uG
Building and Code Regulation Division St. [-ucie GoL111ty/FL
2300 Virginia Avenue,Fort Pierce FL 34982 /
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: 40 _azaawz
Legal Description:
Property Tax ID#: 3`�ll;� �2rf-b�D-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
16,4062 )f' A lGa/ ���9�� iytDTJ� a, 4ple,Cel, � 4x15 )
G A-(= /=L / % � s /4-P u �,-l� n�►ems— /=� 7 � v
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yO's o0�
''CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all=appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor: r �COSI �"—
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/ ESSEE: CONTRACTOR:
Name Name: V4 llbr )0,f¢ Gu++w5-Iy C7f) v.. �VL
Address: Company: Y,"i)r4 c� �� j c,"J uva-
City: State: Address: U ,�� V
Zip Code:,Mq?l Fax: City: State—/
Phone No. ;7Z-371)-75-f 9" Zip Code: 3yf d� Fax:
E-Mail: /a":z2a "rJ_C" C:6 Phone No. 7 7'?),- 4�2r/e—616
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Fill in fee simple Title Holder on next page(if different E-Mail: r M v ( c7 , J @ �a l � G�✓"1
Ca•�cd
from the Owner listed above) 7,:" tate or County License:
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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
commencing work or recording your Notice of Comm enceme
Signature of Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORIDA ' ` STATE OF FLORIDA I r
COUNTY OF d� . 1�1Ci I�i COUNTY OF
The for oing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20[jp—by this C;U day of N O V ,20 V by
(Name of p rson acknowledging) (Name of p son acknowledging)
J�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Id tification Personally Known OR Pro ed Identification
Type of Identification Produced L �.L Type of Identification Produced
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Commission No. (Seal) Commission No. �.�e��,, KAR@N S. NIELSEN
?+ Commission# FF 115637
AREN S. N
KIELSEN " '_
o ;, oc My Commission Expires
;_ -= comm,ission moo,,ovr.�, une
12, 20 18
=_♦ +c puma
Revised 07/15/2014 ag My Commission Expires
�'�' ' June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS