HomeMy WebLinkAboutBuilding Permit Application 08/31/2017 09:15 7724663737 BOYLEAC PAGE 01
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ALL APPLICJBLE NFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date; Permit Number: 1
Building Permit Application
Planning and Development Services
Building and Cade Reguiation Division
2300 Virginia Avenue,Fort Pierce FC 349a2 j
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dmpbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Desedption:
Property Tax ID 1!: l � + -_-- _ Lot No.
_. ...... ......
Site Plan Name; T Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
56W lillq a, Y)tW WA-M& 3,� 40t f 14 SOS AIC, Vile W 0 t d l
CONST :cn:Ohl INFORMATION:
AddifignalworktopPnerformea —under f his perms —check all t=appy:
MVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ElPlumbing OSprinkiers Generator Roof
Total Sq.Ft of Construction:' Sq.Ft.of.First Floor:
Cost of Construction:$ � .d _�DV _ _ UtilitiesSewer 0Septic Building Height:
OWNER/LBSEE: CONTRACTOR:
Name Name: 0
Address: Wq n c. ftxl Company: W P. If Mtyw
City: State: Address:5LD6 +
Zip Code: 5 Fax: City: Stater
Phone No. JI. 1E P Zip Code: 340 Fax ?7a- -3-73-7
E-Mail: Phone No. 11� " 6[-1414-1
Fill In fee simple TMe Holder on next page(if different E-Mail:
from the Owner listed abowe) State or County License:
H value of eonstructlon Is.$7500 or more,a RECORDED Notice of Commencement fa requited.
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08/31/2017 09:15 7724663737 BOYLEAC PAGE 02
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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:
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FEE SIMPLE TRIS HOLDER: Not Applicable BONDING COMPANY: ,,,,,,Not Applicable
Name.• Name:
Address: Address:
Clty'
Zip: ___-__....Phone: Zip: Phone:
AL
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 m►R win out(orize the permit holder to build the subject structure
which is In conflict with any applicable Home Owners Association rules,b1YIaws or and covenants that may restrict or prohibit such
structure_Please consult with your Home owners Association and review your deed for any restrictions whk:h may apply.
In consideration of the granting of this requested permit,l do hereby agree that I will,in an 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 accessary uses to another non-residential use
WARNING TO OWNER:Yaw hilure to Record a Notice of Commencement may resuk 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
lie
,►� _
S�Pature of Owne#AgeWleAe Signature of ContractorAlcensfHolder
STATE OF FLORIDA-LMQ� STATE OF FLORIDA
COUNTY OF COUNTY OF :LW IL
The forgoing instigument was acknowledged before me his Foln Y of ent was acknowledgedbefore me
11r1s? day of � 2O by
7 b�� �
t'7
(Name of person acknowledging -- (Name of persatr acknowledgingT)
(Signature of Notary P tic- of Florida) (Signature of Notary Pu of Rodda)
Persona K o OR Rroduced Identification
Personally Known OR Produced identification k1►
Type of Iden ' Type of itis
CNI115TIM J,CONNLL No1ary PUNIC-S Ids
Commission PIrINC.> I" Commission laabh•II�itF
COMMON•96 01 you Mil Comm.Expires Aug 21,2tM0
kb com.Flares AW 21,2
�OIIOId }glipn�l Nott Rall.
Revised
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REVIEWS FRONT TONING SUPERVISOR PLANS VEGETATION SEATURTLE IIAANGRQV�
COUNTER. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
[1ATE
COMPLETE
INITIALS
08/31/2017 09:15 7724663737 BOYLEAC PAGE 04
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