HomeMy WebLinkAboutBuilding Permit Application May 10 17 04:48p Service Star 407-52766 p.2
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: S 1 Permit Number:
MAY 112017
Building Permit Application ag
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
PERMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line Viv C\C
PROPOSED IMPROVEMENT LOCATION:
�` r
Address: tvl��Y�',r1)V LNe_, .i t' 5A.-
Legal Description: 1�1MAM AER 17-�MES UNI-I U1 - g1-k 4Z Ln IA25
CMA9 3U )075) OY, Z�6CFC;- It)
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: Ml ClhCA 6 �_M orblee
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
HU AC CA-io Y qe du.Y +U a 2- +()r l q Sew I�heexv� -1 P
w 5 )LW DUCT �001z�L
CONSTRUCTION INFORMATION:
it na wor to a er orme under this permit-c ec a _apply:
HVAC Gas Tank awindows/Doors1 ❑
11 Electric U Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: q?o S .Ft.of First Floor:
Cost of Construction:$ q , 100 . 00 Utilities:0 Sewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ti 11 Name:
`'Addresss:5JM3 �1 Y+ A D3 lL i Corn pany:� ILS�m 1�( 1rC1 e�
d)NO
City: f-( State: Ell Address:%IYo f,NW60i tX ';k�j60
Zip Code: '���_ Fax: City: Oyl xy:io Stater
Phone No.51a 35 Zip Coder Fax:Lk) -�1& 2 1
E-Mail: (E1i4ZdXg;6A Phone No_11 r1--I1D � 3
Fill in fee simple Title Holder on next if different E-Mail:
from the Owner listed above) "Mate or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
May 10 17 04:48p Service Star 407-5 '0766 p.3
SUPPLEMENTAL CONSTRUCTION LIEN.LAW INFORMATION: .
DESIGNERIENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip; Phone:
1 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,wails,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 first inspection.if you intend to Obtain financing,consult with lender or an attorney before
commencing work or record)n our Notice of CommenceMen . f J
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF �(
i COUNTY OFa�
The forgoing instrument was acknowledged before me The forgoing instrument
`wads acknowledged before me
this Ja 4Jay of �JA 20)a " tr by this Uay of �r+ u t 20 by
x
(Name of person acknowledging) (Name of person acknowledging)
ignature of Not770A
State of Florida) ignature of Notary Publi Sta e f Florida)
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced Commission No. (Seal) Commission No. V rr,,
(Seal)
Revised 0"/1512014 ^ AlotasyPubltasht dFbdda
Amanda LItUe Notary Public Slaw of ftoride
f°'io'r'E, ExairM Otl1t 020 y Cunmlaslan FF 951 4a
REVIEWS FRONT NS VE T 0 11114O E MA ROVE
COUNTER REVIEW REVIEW REVI W R
DATE 3
COMPLETE
INITIALS