HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: X11117 Permit Number: l l lJ'J' 0
Building Permit Applicatio
n
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 -D
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: j =
Address: ZSZ :5E ?i4namyrl'S�Ct���V
Legal Description: 5u_ Ay6rl *z§041,6 a`octa
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Property Tax ID#: �y�9- ST d ` �J 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF WORK: ;
,
S• �e_ d&CL 60II&A AepAbti-40Y) a- tf_5i d o•
CONSTRUCTION INFORMATION':
Additional work to be performed under t ispermit-check all at appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR: i'
Name /N% Ot L Z-/,/ Name:
Address: lit). _52o 41W �IiY, 7512 Company:
City: /01W kState: Address
Zip Code: h0 ( Fax: City: State
Phone No. VY3 6'10 — Zip Code i ++ ,A,1Fatx:
E-Mail: WB Phone N .—a- Lc�
Fill in fee simple Title Hol r on next page(if different E-Mail:'
from the Owner listed above) State or County icense:
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: __X Not Applicable
Name:'&Ke-v t`t Name:
Address: 30-SrAddress:
City: State: City: State:
Zip:33y3t Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDEN Not Applicable BONDING COMPANY: . Not Applicable
Name: t�iuo ��4 0- Name:
Address: 37PY W- ;SWdAn AIK,-5W 2-CO Address:
City: L City:
Zip: 5f r) Phone: W — 7 > 1700 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 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 financi onsult with lender or an attorney before
commencing work or recording our Notice of Coaimencement.
Y)C.0.S
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Signature of Owner/Le Factor as Agent for Owner Signature of Contrd License Holder
STATE OF FLO STATE OF FLORIDA
COUNTY OF v'00 COUNTY OF-� �
Theforgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this V dayof 20 'Lby this LL day of 20 aby
� 1 Yh 1M OVl
(Name of person acknowledging) (Name of person acknowledging)
(Signature of 9dary Public-State of Florida) (Signature of Notary P - tatetate of Florida)
Personally Known__X_OR Produced Identification Personally Known \1 OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. o mission No. - '
N `'` 1{6�4TI}NER HARDEN
<z°` 'r, ��-4 /�+5HLEY H. C�iUI(T '• °� Commission#GG 2
h2 5312
SIGN#FFM 98 My commission Ex Ores
EXPIRES May 73, 2018 August 28, 2020
Revised 07/15/21014 °`CoQ,.
(407)39"153 FloridallotaryService.com
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