HomeMy WebLinkAboutBuilding Permi Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: I Permit Number: vo
Building Permit Application JUL 0 6 -63'W
Planning and Development Services PERMITTNG
Building and Code Regulation Division St. Lucie Couritv. FL
2300 Virginia Avenue,Fort Pierce FL 34982 Residential �
Phone:(772)462-1553 Fax: (772)462-1578 Commercial F3_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT, LOCATIONI 0
.'
Address: ' 001 AVen14f Q r-of AeI r"oI e.:
3J4qL1 9
Legal Description: Ektellm,�4 Onql-denjS fw Ile EL>1 ic; IF-rco f: L-o+ 3 4-S
5T" Lr,, 1-m A. I 0f+- (V,�(D 194or -mi - IqC4,9 ; qq D-GL-i 0 1c)I S-03)
Property Tax ID#: dL-f 5 5 - b Q I - DR-q3 �J' Lot No.
Site Plan Name: Block No. Lp
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION IF WORK:
12er-nove _e4s+- n rood Sv1,4trj of G'V00 tc> PL&O0,;L1. � -0,a. -� 0-10Y
tylSia lt SD (bs I �a r- O�Y� 4io _b,;t�S Lf e-
C)-to-tto s Corninl ShinT-e
CONSTRUCTION INFORMATION:,
Additional work to be nartormed under this permit-cleck all apply:
[=-IHVAC Gas Tank E]Gas PipingShutters Windows/Doors-
Electric Plumbing OSprinklers M Generator Roof LF47 i I Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction:$ Litilities'll SewerE]Septic Building Height:
OWNER/LESSEE: CONTRACTOR.
Name MC I V('n:a�_elf Name: Sf Ke-r2:i 14ASly
Address:,L1001 eV1zr)XJ G'? Company-s-I.- L4_t::� on'
City:74 �+_ 1 rGt State::4�(_ Address: 1115 L`3 MA&3 r6kv"�_
Zip Code: �qrl Fax: city: eor+ 4 k t�--k- State:
Phone No. '7 '7,9 9-3 1 Zip Code: 2"4*1 Fax: 9U_-aZ 9-
E-Mail: nIA. l'i 0Y\-f Phone No. -7 -7-,7-3LfLi- 91
Fill in fee simple Title Holder on next ge if different E-Mail: @1
from the Owner listed above) State or County Lice%W-*'1 M DI
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: _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:
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
--- . — , . "� 4 k_-- s
Signature of er/Lessee/Contractor as Agent for Owner Signat re of Cffhtracr/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF R+ Lu &I 'U COUNTY OF St (iuC�c
The fprgoing instrument was acknowledged before me The forgoing instr ment was acknowledged before me
this day of ..t 20 Eby this 5 day of 20 2 by
m,e r,%.,j es JLW_r_�v igAn-ria�!oi
(Name of person acknowledging) (Name of perso acknowledging)
C "� 0U P_,CA�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification �— Personally Known r OR Produced Identification
Type of Identification ProducedType of Identification Produ
osi (CON&YANCE PROULX
Commission No. - - Commission No. MY(CSf9*ISS)ON#FF 160517
: W ' Co. STAN E R®ULC �% p. .' EXPIRES SeOtember 16,2018
RAY N#FF 160517 (407)398-0153
Revised 07/1 -0163
EXPIRES S tember 16,2018
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