HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 a' ��' �Q Lo Permit Number:
RE"EI ED
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Building Permit Application
DEC 2 9 2016
Planning and Development Services PERM ITTING
Building and Code Regulation Division 5t. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:' — VowLL#ROWE�1111ENT L®C TION u
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P4,uu�r�Gv'sc��..n§ '^nn - °u.A;ii'�r� * t:�,: ,�,�. srk, �
Address: - eYCe,
Legal Description:
Property Tax ID.#: 133 37 --4 Y1 - 6700 - 0 L2-elr Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED�DfSCRIP�TIONQFWORK� "' � �� ��� �
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C®NSTi UCTION INF�®R11/I'ATION.:" ` � 4 o-
Additional work to be performed under this permit-check all that appy:
—Mec anical —Gas Tank Gas Piping —Shutters _Windows/Doors
P Electric Plumbing Sprinklers Generator Roof
— — g — p — —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 1000, 1111 Utilities: —Sewer —Septic Building Height:
�0 NEER>,E SS�EE� � g ®NTRAC
Name L6&_Alar_co.rl-r LZ C Name: d 7-ho
Address: 19,6 Company:
City: ur; State:F/ Address: !�/
Zip Code: ► �S"„i'� Fax: City: .1-t State:
Phone No. 772 3-�3- IVOJ � Zip Code: Fax: 77.2
E-Mail: Phone No 77a 6"_70
Fill in fee simple Title Holder on next page( if different E-Mail yg J om. car"
from the Owner listed above) State or County Licensee-®®� 7 e�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPt��E11/IENTAL CONS`'TR� C1"IaN LIEN LAUI! I;N�FO,R�MATIQ(V;
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 recording our Notice of Commencement.
L#
Signature o Owne /Lessee/Contractor as Agent for Owner Signat re o Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF i LU 0"'F COUNTY OF A. I k I
The for oing instr�umennt was acknowledged before me The for oing instrument was acknowledged before me
this day of (I . 201p, by this day of�� '?. 20�6 by
( e of person knowledging) (Na of on ckn'owledging)
10 _AA '�_ , AA
m
(Signat re of otary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V) Personally Known OR Produced Identification y
Type of Identification Type of Identification
Produced F ced
KAREN S. NIELS N
d4�ar vuB o
Commission No. ;�1Seel�mmission# FF 115o ission No. _ """
� ,..• B�Seai�AREN S. NIEL E
-+ - My Commission Expires ;po ��.;
a; Commission# FF 115 7
OF F��•``, June 12, 201 8 o My Commission Ex it s
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEXITM= MANGM!
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014