HomeMy WebLinkAboutBuilding Permit Application a 'r
All APPLICABLE INFO MUST(, BE COMPLETED FOR APPLICATION TO BE ACCEPTED n Li- D 1
Date:
0 1 �sPermit Number: �' V
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Building Permit Application 0?418
Planning and Development Services ktv�Depart
Building and Code Regulation Division a Cbts17®at
nty
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial. Residential
PERMIT APPLICATION FOR:Q�� ,...4.
PROPOSED INPROVEMENT _OCATION .a_
Address: 701. Uj `J c /.k./.P\-?i 2cG.2_,
Legal Description: `1)e,c'bA-0 I,N.Z b,-0%f\A- ?,2.. Y�-epkaCU �Z-
Property Tax ID#: 1437-q,O(0-O kD _ )0--� - Lot No. ZZZ�
Site Plan Name: Block No.
Project Name:
Setbacks Front- Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
—Mechanical —Gas Tank —Gas Piping —Shutters _Windows/Doors
Electric:,. Plumbing —Sprinklers . _Generator oof /JPitch
Total Sq Ft of Construction:= 1 t2/ . Sq Ft,'of First Floor:;.
Cost of Construction $„ Y/ LS-a-00. Utilities .,ewer Septic Building Height:
OWNER/LESSEE CONTRACTOR.; ,e a
NameA.;1- (1v'e-- % AM.',v\ Name:DtrI r O S COCI-S (A.CtJ 0AA- LI-C
Address: 7 a-114./ {„c-D`c- Company:9>nC�-cR r✓ �v cl,LcicAZ) LLC_
City: A N_\= i,eS ea_ State: Address: 2;70(o k C1., G A V-C_
Zip Code:314U Co Fax: City: 74- i e 0.2.- State
Phone No.1/z Z\C 55- -4-1- Zip Code: litiR 7 Fax:
E-Mail: Phone No 711— 4 -4 Cf 16
Fill in fee simple Title Holder on next page(if different E-Mail'1� , 'kms\A1--pS, S {K' 9 ori•.Cc
from the Owner listed above) State or County License �,C.,‘,-\7.-7-7....7..,6
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: _Not Applicable
Name: Name: `
Address: \N-- Address: /\\/ \i_\,‘"
City: State: City: State:
Zip: P one Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
\NIA__
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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 fi st inspection. If you intend to obtain financing, consult with lender or an attorney before
corn encil work or recordin: our Notice of Commencement. A
A
A-
:9ure Of
..►t .�,—� Nom sawurr
of Owner/Lessee Contr:ctor as Agent for Owner Signai-re if Contractor/License Ho der
STATE OF FLORIDA(' , 4Q STATE OF FLORID
COUNTY OF 1� COUNTY OF J „AAA 6::t, e---
The forgoing instrument was acknowledges(before me The forgoing instruffw�ent was acknowledged before me
this A day of f-kr-A ,20 Fb by this /4day of it?t1 ,20 1 D by
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1)(04
cti.A9)/te,„‘,1
A(Name f person acknowledging) (Name df person acknowledging)
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