HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE'COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: 1_t �1 Permit Number:
_ RECEIV71 JAN z 4 7.017
Building Permit Application
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 v""
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Ke ,Ne-J-k :ia-v\
PROPOSED IIVIPROV,EMENT LOCATION r
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Address:�f-00 SV-)CLnnQt�:1:)ziye . ��.���2C i -'Z -,3,-I9s I
Legal Description: W 0,%3 pk'4V_t� - 010j_71- 12.- _J:: Ll1 I SC- M Vb- OF wr I -I- 1't1.1
s SO -as fit. 01P LDTa0 ( MAP 1311 a S) (-n R 2A -I x'32) j/5- T, A4D
Property Tax ID#: 1 -00q!; - OCp-- 9 Lot No..s LX Lc 17
Site Plan Name: Block No. 5F5'
Project Name: C�bQ h
Setbacks Front T— Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF WORK
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CONSTRUCTION INFORMATION
_ . .
Add itio.nal work to. e nertormed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping E]
Shutters ❑Windows/Doors
Plumbing Sprinklers Generator Roof Roof pitch
Electric 0
Total Sq. Ft of Construction: ISS �: S .Ft.of First Floor- 0Q�
Cost of Construction:$ Utilities:li Sewer _Septic Building Height:
OWNER%LESSEE CONTRACTOR
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Name53�-rLT CC&I+L•A�S Name: P NusO� AG�A�l��-t'nC)
Address,-55p � ShEmo.5 �QAd Company:R)Lc/w ibn X .6'Y.'l_CLr,<4,aI D 2:
City:}-. agLce State: Address: 1 t
Zip Code:Sq q5` Fax: City: aJn_2t Stater
Phone No. 132 - tla - 9(D'&y Zip Code: Ncig-T Fax 7�� -cptz •5'r�3
E-Mail: CL 00-00M Phone No. a?` V
Fill in fee simple Title Holder on next age(if different E-Mail: C%(- Se_ 0 C'OASzA df<c .C0
from the Owner listed above) State or County License: c1&C_057r[160
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: S Name:
Address: :3G65,2. -A1ALyf,i PPZF,U- ddress:
City: 2L State: fj City: State:
Zip: :)&2e Phone:?a1- • (�f"+f`3C� Zip: Phone:
FEE SIMPLE TITLE HOLDER: :Z'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 r corded and poste on t jobsite
before the first inspection. If you intend to obtain financing, consult lender or n a rn efore
commencing work or recording our Notice of Commencement.
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Signature of O er Lessee tractor as Agent for Owner Si ture of Contracto Licen a Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF � COUNTY OF �)nCA "
The forgoing instruwas acknowledged before me
this 4--day of The forgoing instrument was acknowledged before me
c 20 Lby this_6 day of 20 L by
U t . l se'r-+ le se k/
(Name of p rson a nowledging) (Name of per s acknowledging)
(Signatur�NoPublic-State of Florida) (S' "n re f Notary Pu - tate o orida)
Personally Known OR Prod ced Iden ification Pe sonally nown �OR Produced Identification
Type of Identification Produced b Z- 3 �' Ty e o entification Produ
KYLE/ J :`a: " )KYLE DAVID EI €aT %�3 •` 't DAVID EFso ss
Commission No. �'G3 ( ERT
���P. eal mi sion No.
MY COMMISSION#F 0311511 �'`.!?�Q��o?°' EXPIRES August 30,2017
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Revised 07/15/2014 (407)398-0153 FloridallotaryService.com --
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