HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO Mirr BE Coamqmw FOR AFPidtAi'IflHMTEiBEAC,£€P3Ei3
Date: I 41LQllq
CONTRACTOR:
Permit Number:
Name 1'""
Address:ty�()1 �P,1r�5� � �
a %�2
m
Building Permit Application
lid(/(City:
MCI
Planning and Devetopmenf Sen kes
Address:
Building and Code Reguhrtiar DMskn
/
2300 Virginia Avemr, Fwt Pierce F134982
E -Mail:
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
E-Maik bn•�\,/10 0 _C of� 110
10 . n ro
PERM!i APPUCAT(ON €OR: To Seked from x, click arrow the of r
PROPOSED IMPROVEMENT LOCATION
_ ;
Address: 501 Q, , $ I
+GC. • ( C 3 �
Legal Description:aoish L i l S i(Vialf
Property Tax ID #:
Lot Na
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back -_Right Side: Left Side:
DETAILED DESMIPTiO OF Wt)RK:
Lilo for Like : s l l �z vU Yioj�dair¢ 3.5 ion
CON = UCTI ) ll FO l�`dATI .
na vvo to r perst— a app -
bas Tank Glias Piping O
��[[NVAC pp—�y j jam_ Shutters Windows/Doors
DEle
! _4 P#umbing 11spsiniders t. _# Geneaa€or F1 Roof
Roa pitch
Total Sq. Ft of Construction: Ft. of First; Floor-,CostofConstruction.
$ 4000.00 €#tititiesiSeaver 7 -Septic Building Height:
o, NER/LESSEE:
CONTRACTOR:
Name 1'""
Address:ty�()1 �P,1r�5� � �
Name:
Company:
lid(/(City:
MCI
C U ( Stater
zipCode: 3 Q5 rrFax:Y'
Phone No. rJ 1-1- A I 0 - lP f
Address:
�"�dQ�-
L
city. -M( -E;
Zip Code: S
Phone No. 1�
State:q�
Fax: TU - � Utz -3-7 31
4 l
E -Mail:
Fill in fee simple We Holder on axn€ page (if different
from the (Amer listed above)
E-Maik bn•�\,/10 0 _C of� 110
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State or Coder
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; _ Not Applicable
Name:
MORTGAGE COMPANY- Not Applicable
Name:
Address:
Address:
City; State:
Zip: Phone
City: State;
Zip: Phone:
EEE SIMPLE TITLE HOLDER; _ Not Applicable
Name:
SON IG COMPANY- _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRAC-10R AFFIDVIT: Application is hereby made to obtain a permitto 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 {
which is it
structure.
ermit holder to build the subject structure
covenants that may restrict or prohibit such
it any restrictions which may apply.
In consideration of the granting of this requested permit, h do hereby agree that h will, in all respects, perform the work
in accordance with the approved pans the Florida Building Codes and St: Lucie county Amendments.
The following building permit applications are exempt from undergoing a full concurrency revievic room additions,
accessory structures, swimming pools, lenses, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNM, Your falture to Record a Notice of Commencement may ressdt in your pay i tg Mice for
improvements to your property_ A Notice of Commencement mast 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 ur Notice of Commencement.
Signature o Owner/ Lessees/ ctor en ,Owner
Signature EorrtractorJUcen
.
of a Holder
STATE OF FLORIDA
'5 l P�
STATE OF FLORIDA
COUNTY OF .
COUNTY OF 1+ (y
The forgoing in mentwas acknowledged before me
The forgoing instrument was acknowledged before me
this 291' day a# 13-Dri 1 20161 by
this2aL�dayof %�pt'l�_I 20_a by
Mcme,f -r
�Lichae� r fx��{I
Name of pepFrrnaking statemelit
Name of person making stakement
Personalty Known OR Produced identi,4cation
Personalty Known 7/ ORProduced Identification
Type of Identification
Type of Identification
Produced
Produced
CIA
{signature o tyt ° °'` b5�tt�t g
il; nvr�rT-�II®NL *Wslaf Florida
wzd
(Signature of Notar° of t#
g €
_• t •_ - Commission M GG 017839 (so>t
Eommiss'so �e Ez fires til 2020
gr, tao ary PuUZc - State of FLI nda
, : •= Com slog # GG 017829
Commission No, %�
,,�I^�"„• . p
"����.• Bonded through National NotarysAssn.
,," "� r op'� My Com . res Aug 21 0
Bondetl through National No(a
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Rev_ 8/2/37