HomeMy WebLinkAbout1636 nw buttonbush cir permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ! �j Z� Permit Number:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ) 616 V) -++or\ b v S 6 C '
- L_
Legal Description:
PropertyTaxlD#:�(�26 H0- 0015 000-W Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks `'Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
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cin�cQ 113 r Swr
CONSTRUCTION INFORMATION:_
Additional wor to a oerformed under this Dermit -check all that aoo v:
OHVAC LJ Gas Tank
[aJElectric I Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 79 0.0 r7
Piping L _1 Shutters
nklers OGenerator
S . Ft. of First floor: _
Utilities:ll Sewer a Septic
QWindows/Doors
11 Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR•.
Name6, S A
Name: Ir r i c L_ e t ours,ecLy
Address: 5 ++2)
Company: Wi (-e. t\ y+r_ i A c.
Address: d 4 onina,neclet N V Q
City: QO 4` _ State: L�
Zip Code: Fax:
City: o r Q f eas, Stater
Phone No. Z" 1
Zip Code: 3ggc'T Fax: % AL 050
Phone No. 772- 4 6- QS O o
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: W + ratty+� `t AC, 0 � CJ . (-0111
State or County License: E.� 130065 I `7
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 recorded and posted on.the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recording our Notice of Commencement
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA C
Lv�,
STATE OF FLORIDA + Luc;
COUNTY OF
COUNTY OF
The for ing instrument was acknowledged before me
The forgoing instrument as acknowledged before me
'a
this 1 ay of f UQVC.M. b) _( 20 21 by
this )5-MN day of 0VeN2071 by
Name of person making statement
Name of person making1tatement
Personally Known ti OR Produced Identificati
ersonally Known V" OR Produced Identification
M
Type of identification
p %
Type of Identification
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Produced
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Produced
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(Signature of No ary Public- State of Florida)
a' £
(Signature of Notary ublic- State of Florida)
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Commission No. QJ (Seal}
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Commission No. ! S5bd S (Seal)
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REVIEWS
FRONT
ZONING
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PLANS
VEGETATION
SEA TURTLE
MAN
COUNTER
REVIEW
R
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17