HomeMy WebLinkAboutBuilding Permit Application_ -1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number• 1 l Q, i - 05 0(O
Building Permit Application itiL `i��l
Planning and Development Services
Building and Code Regulation Division PER►VIITTING
2300 Virginia Avenue, fort Pierce FL 34982 St. Lucie C u lye FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION
Address: ? R (., N � �-� s t3 L v D Tc N 5 c-+^j, i'= <- • "3 `t 7 S 7
Legal Description: rsC-ra-Arn = permc_z 7ci6
fiw 0 P 9-0 — /Z t3r'rn S' 0 A-1 -f- / r•-' G o t u w� a a � er G- r,. �v rs o r- CLI aa'J - ( c z z]
Property Tax ID #: S U 2 - _�5_U ! - 9 G 2 - 6 C)-o ~ F3 Lot No. % 9
Site Plan Name: Block No.
Project Name: _ _ IW X -1 LS rz- (3, r �
Setbacks Front t 8 / Back: /1 /A Right Side: / 7 • S Left Side: 9_5
DETAILEDDESCRIPTION'OF WORK:
`oJ N Y Tn- V GT A n/ O) At(,
CONSTRUCTION INFORMATION:'
Additional worK to be erformed under this permit - c ec all apply:
�IHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers ElGenerator 11 Roof Roof pitch
Total Sq. Ft of Construction: '3 Z 1A S . Ft. of First Floor:
Cost of Construction: $ / o -0 a : � Utilities:ll Sewer E]Septic Building Height:
OWNER/LESSEE . " . . ,
CONTRACTOR: .
Name 5 c o ,—� C N Aff r
Name: /Z tk n-mo_
YF' Ak1--i /4- _ y.
Address: L l l (3 V a.ti, S j v7 r, i72 .
Company: 5 Ro- -eLj, L
2, v - &m %t e rir,t,e-
City: 14 R'YL60 /2 tw P State: 1
Address: I zq o Aj
r3 v sNrt e�.
Zip Code: �'� �3`/- Fax:
City: -SetN se-7j
State: r L
Phone No. O _ -3-9 S_ 7 Z' I
Zip Code: 7 4 5 S?
Fax: 71 Z -3 7
E-Mail: GL Y YI-
Phone No. 7 -1 Z-- - "3
3 -t- `-( 3 3 y
Fill in fee simple Title Holder on next page (if different
E-Mail: 2 F M 9 8 i s- C?
from the owner listed above)
State or County License: C/z_C_ .0 S -7 7-
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN* LAW INFORMATION: -. •.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: A v Z- IZ, V 1+ L C t_ C_6
Name:
Address: 13,8 5, 'c N A g A ,J g-rt A v&
Address:
City: State: 'F L ,
City: State:
Zip: '3 y Y S '1--Phone: R -n - 2- Y 5'Z—
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phon
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
commencing work or recording vour Notice of Commencement.
re
STATE OF FLORIDA
COUNTY OF ,
as Agent
The forgoing instrument was acknowledged before me
this cg-1 day of 20 L by
(Name of person acknowledging)
,(Signature of Notary Public- Stat&of Florida )
Personally Known FOR-Produced:ldentification,,-,:,
Type of Identification Pro' �"v'''-'. LASHAHNA INGRAM
tt�,>'cj_�
a n Notary Public - State of Florida
Commission No. N inMy (S'ga`I)• Expires Dec 20,201
( ommission # FF 177249
Bonded through National Notary Assn
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OFSt.r o
The forgoing instrument was acknowledged before me
this day of 011 20) by
(Name of person acknowledging)
/4,16X" �'
(Si na ur of Notary Public- St a of Florida )
rsonally Known OR Produced Identification
3e of Identification Produced
.........
.'^..., LASHAHNA INGRAM
mmission No. *`' ` aY ' ��a(S,"Oy Public - State of Flc
u My comm. Expires Dec 20,
"
dad'-6 n. r -;-inn A FF 1772,
Bonded through National Notary
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