HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�W(Pbaon Y Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone:{772)4.62-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Seleet from dropbox, click-arrow at the end of line
Address: Q90 �JF_ 'SvmrYTeY- Zd .
Legal Description:'River Po,,/ - U r14l ?off` L 13.1k -79 L-o+ '4
Property Tax iD#:_JL4 19 1;'70 - CC)tad - 000 Lot No.
Site Plan Name: Block Na.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILEC DESCRIPTION OF WOR'!
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CONSTRUCTION INFORMATION:
A�drtionai workto e e orme under.this permit-c ec a appy:
OHVAC Gas Tank as Piping. Shooters Mlinrfows t?oflrs
Electric QPlumbing prinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: 2300 Sq SQ.Ft.of First Floor:
Cost of Construction:$ R X5 0 Utilities:11 Sewer F]Septic Building Height:
OWNER/LESSEE: -� CONTRACTOR:
Name CS l em Alan AEdwa,-J s Maine: A S
Address: alt". NE 5jmme'r Company:-.15 (Zwf-!4 -t 1, +rprpoF4'nq
City: Z�+ 5a(ri't' Lucd&_ State:,. Address: 3lo'i % 4AeaL4 hv+ddd Ur
Zip Code: Fax: City: AA-_CQ%V1r Looe State: K.
Phone No. '- `1I'� - ag{o - dodo Zip Code: �SLJ9S'oI- Fax:
E-Mail: Phone No.
0111 infee.sl npteTitle Holder on.next. (i#di#ferenS E-Mail:7b raa i r�of _�n _ QVY1cxt I • ty�'�
from the Owner listed above) State or County License: C CC 13 3 O s-1.1 G
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
I City: State: City: State:
Zip: Pho-me: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _/1Vot 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 1 will,in all respects,perform the work
in accordance with Lhe approved plans,Lhe Florida Building Codes and SL.Lucie'County Arnericirnents.
The following building permit applications are exempt from undergoing a full concurrency revievd:roam additions,
accessory structures,swimm.iingpoots,fences,walfssigrts,screen rooms and accessory uses to another.:non-residentia 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
comme,pci.ng work or recording our Notice of Commencement.
Sig re of Owner�Lessee/Contractor as-Agent forOwner Signature Gantractor/Llcense Holder
STATE OF FLORIDA Q'I , 1 n l STATE OF FLORIDA i , l
COUNTY OF COUNTY OF J C,I
The f�r^going instrument as acknowledg efore me The orgomg instrument was acknowledged before me
this May of � Toby ( this W day of 73. l„)nQ 20 a by
(Name of person acknowledging)' (Name of person acknowledging
le
�_.
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known x OR Produced Identification Personally Know OR Produced Identification JI
.l Type of-identification Pfoducc}e-d�t Type of.identin"cation.Produced
Commission No. (& -I 1 Seal Commission 4aC1 ZlQV 7,( (Seal)
ASHLEY LAWRENCE -
o. @N
uc
EXPIRES:SEP 13;2020 MY COMMISSION#GG029�21
Revised 07/15/20.14 �A Bonded through tet State Insurance , EXPIRES:SEP 13,2020
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