HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / /J
Date: Permit Number:
ECE
Building Permit Application NOY 2 9 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PffNffM,,Q IWROUEMffLOTIM, /
Address: _'f/� �r7 a 141�or2- —� G� m d
Legal Description:
Property Tax ID#: ? �, lq— .9- 3 3 000 f —O 7'd IP Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: d Left Side: l�
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GO �T � FO " TIO
d11f=i worK to De perTormea ermit—c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprin _Generator _Roof Pitc
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ O 6;7tilities: _Sewer _Septic Building Height:
Name: r �: �� u� Name: . ' `pyi —7c ri r 2-Z
Address: (9.D - �o�` rrs��nir�.rr� � Compan ilu! e2�4" ,� c`I
r �/ .y_ TY`UCf/yh C a
City: fi Pr��.� State: f—;'C- Address: 0'aW. /•
Zip Code: Fax: City: )0 4, Lyc l 'State:_L
Phone No. 772— 3 " 't)�3 Zip Code: S. Fax:
E-Mail ® 0_n Phone No -2 7 2 — 3 .5 �—6 D Q
Fill in fee simple Title 401der on next page (if different E-Mail 54a y\-4,e PA a�, h 3g d, Q 6&PW i
from the Owner listed above) State or County License C 6. C O / k_�'.-R
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 411,113
SUPT EMENTAL C®NSTRUCTION LIEN LAIN INFC?RMATI19R
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: bcwl S b Name:
Address: 7 &bJ glz(ua e 4* y iso J Address:
City: 41 Vt CA, State:-L City: State:
Zip: 3277 Phone �07 — 31?- 23 3 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 inspe;tion. If you intend to obtain financing, consult with lende r an attorney before
commencing work;6)rgeorcling your Notice of Commencement.
Signature n r/Lessee/Contractor as Agent for Owner Signature C actor/Li ense Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF CJ`" J COUNTY OFic�
The f r ng instru e t w acknowledged before me The ing in u/��was acknowledg d before me
thi�day ofAA/ 20jby thiday o� ,2 �by
(Name of person acknowledging) (Name of person acknowledging)
( ignature of Notary Public-State of Florida) /,.ISignature of Notary Pub ic-State of Florida)
Personally Known OR Produced Identification l� Personally Known OR Produced Identificati
Type of Identific ' Type of Identif�ca.' I S NIELSEN
Produced NIELSEN Produced ,���: KAREN q FF 115637
„ ernrr � 7 =� mission Expires
yea miicessior•q FF 11563 a MY commission
fres 2 O1 8
Commission No ,9 �� Com ommiss 98 Commission No. °,. (1 ) 2
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12. 2 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.