HomeMy WebLinkAboutBuilding Permit Application A �
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 17 Permit Number:
703 . 0�
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Building
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential �Y1
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address: I�r :5EI .410- Gk '
Legal Description: See. Al tJ1 abf '66 mtk
Property Tax ID#: Jy l "s'i " (!)I
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Lot No.
Site Plan Name:_"Wo- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:1
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DETAILED DESCRIPTION OF WORK: .
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=CONSTRUCTION INFORMATION:
Additional work to be ertormed under tispermit—check a [hnappy:
❑HVAC Gas Tank Gas Piping Shutters II Windows/Doors
Electric ❑ Plumbing Sprinklers 1:1 Generator E:] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �%7�� Utilities: _Sewer 11 Septic Building Height:
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O /LESSEE: CONTRACTOR:
Name Q Lu Name:
Address: 37072' AU Sflll �d Company: I -
City: State:�L Address: J � _
Zip Code: G0 9 Fax: City: 7-• f Lie State:
Phone No. :.3 616 X � Fax: 7
E-Mail: r2,. CO Phone No. 7
Fill in fee simple Title Hold r on next page(if different E-Mail: .Y)a 0Ll►r)S AV1 y-% '. rJ e—t'
from the Owner listed above) State or County License: C 60el g,
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Y,Not Applicable
Name:-BAk"tt Name:
Address: 0'57'E Address:
City: State: City: I State:
Zip:33g3l Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDEN Not Applicable BONDING COMPANY: XNot Applicable
Name: 90 N11u�4_W*_- a. be " LLL Name:
Address: 37v W. Swom A%R- 5k 2-CO Address:
City: L City:
zip: .356,01 Phone: 3- 17V- 1700 Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit.
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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 recordin r otice of Commencement.
1;341NMUDUY_
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Signature of Owner/Les Cont or as Agent for Owner Signature of Co tr for/License Holder
STATE OF FLO ID STATE OF FLORI
COUNTY OF COUNTY OF t•LOCA if
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of OG,,(C\/\, 20 by this 3 day of {Y'1 a�G(%� 20 1 by
'7i�j1 (1\cna1cJA1 butcv- Y_h
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(Naitie of person acknowledging) (Name of person acknowledging)
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(Signature dfflotary Public-State of Florida) (Signature of Notary Public-State of Florida) .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
.. Y°6a,'•': qg Y H. GUYTON EN
Commission No. =_°' ",�': �S�a Commission No Ajy{ER E��
`= MY CCDM ISSION#FF111198 �„� , 5312
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EXPIRES May 13, 2018 8=o w' Com mission Expiros
(ao7)ase-0153 FloridallotaryService.comV
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Revised 07/15/2014 ' or� A gu
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DATE
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COMPLETE
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