HomeMy WebLinkAboutBuilding permit application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fl' Lf. l 7. Permit Number:
RECEIVED
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Building Permit Application JAIL ' 8 20f7
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: P
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PROPOSED IMPR�UEM1ENT LQCATICiN
Address:
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Legal Description: 6?3 '?3 1 7e/ ^ 0 0_-7'C( D o o q
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Property Tax ID#: Lot No.
Site Plan Name: Block No. L3
Project Name:
Setbacks Front Back: Right Side: 5 Left Side: V2
Q.ETAILED DESCRIPTION QF WORK
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/90 cq r C o r1 C('
CON5TRLICTION INFORMATION µ
Additiona I work to e e orme unclert ispermit—c ec a appy:
11HVAC E]Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: /��� S . Ft. of First Floor:
Cost of Construction:$ �,7�� Utilities:0 Sewer Septic Building Height:
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01NNERjLESSEE CONTRACTOR x
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Name G to(`r A k'a Name:
Address:_G!l ��. .,v! e.so 44 C- P, h�� LCompany: �' 7c �[� �� •
City: �, v� C i •e Ci' C State: ( Address:
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Zip Code: 6/ i Fax: I City: 57�I�1�1, 1 State: L
Phone No. �=(rQ Iq - � to to Zip Code:3 q /c7 `7 Fax
E-Mail: Phone No. ')?Z
Fill in fee simple Title Holder on next page(if different E-Mail: P�lgJ�kXIZ�G��4U1�• CAA'` '•
from the Owner listed above) State or County License: C-- 6147 J
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name: F&k A)
Address: Address: . D f6o 56 30 v vS.
City: State: City: l/ "r State:
Zip: Phone: Zip: '1 2-So hone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Lo A.t Name:
Address: 7 1—,-4 Address:
City: City:
Zip: q66 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
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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.
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Signatur wner/Lessee/Co tractor as Agent for Owner Signatu Contractor/LicenA Holder I
STATE OF FLORIDA STATE OF
COUNTY OF -UkCFC COUNTY OF FLORIDA,
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The forgoing instrument was acknowledged efore me The forgoing instruEetit was acknowledged before me
this VK day of 20 by this day of J Ct � .20 /1 by
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(Name of erson acknowledging) (Name of person acknowledging)
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(Signatu e f Notary.Public-State of Florida) (Signature q plotary Public- of Florida)
Personally Known y OR Produced Identification Personally Known_�OR Produced Identification
Type of Identifi 1531'.217OULMU Type of I • '
ETRES ��"P)''•• AM Y R.MCPHETRES
_ Commission#F
Commission N - : ��44,,� 8g Commis c; ( •__ Commission#FF 141668(Se
res August D,'EA P: xpfres August 16,2018
,' Pmf�`•• eorddrMu Troy Fein luuroroaOOOJB5.70f9 • P, •f,q`•� 8°"ded Tfru Troy Fem ln�urenee 000J85.7018
Revised 07/15/2014 j
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