HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date:` X.�' ` %1 Permit Number: 1i�� dad 1
T RECEIV 1 SEP 18 2017
• _ _ 5 ..�?rite
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 114
/ac"1 �5'GY�''S l
/�c.Jel �' ZL 3
Legal Description: .�`'7
Property Tax ID # 1 '*\ �3 V54 a - G id\- O (50
Site Plan Name:
Project Name: yllo-L , 6 Ga
Setbacks Front Back: — Right Side:
DETAILED DESCRIPTION OF WORK:
INSTALLATION _
Left Side: �ea
Lot No. 1.3
Block No. 15
CONSTRUCTION INFORMATION:
itiona work o e e orme under this perms -check all that apply.
�HVAC Gas Tank ❑Gas Piping O
Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ -)li Q� Utilities: _ Sewer F]Septic Building Height:
OWNER/LE SEE:
CONTRACTOR:
Name OC 6-77 VS �/L� w%
Name: BARRY MILLS
Address: W )on itI-Ad JtV
Company: CRYSTAL POOLS OF INDIAN RIVER
City: t� ^'�'Y'� State: FL-_
Zip Code: �'1� Fax:p
Phone No. S' .'�) l
Address: 4680 US1
City: VERO BEACH State: FL
Zip Code: 32967 Fax: 772-770-5961
Phone No. 772-567-3067
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: JIMMYR@CRYSTALPOOLSIRC.COM
State or County License: CPC1457120
it value or construction is 525ou or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
^
Name:
Address:
Address: y
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:
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- Olzur failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo roperty: A Notice of Commencement must be recorded and posted on the jobsite
before the first ins a ion. If you intend to obtain financing, consult with lender or an attorney before
commencing w recording your Notice of Commencement.
k9naturcrof Owner/Lessee/Contractor as Agent for Owner Signature of Cont actor/License Holder
STATE OF FLORIDA 0 STATE OF FLORIDA
COUNTY OF Mn -f. COUNTY OF 1, t/4'0
The forgoing instrument was acknowledged before me The fgtgoing instrutpent was acknowledged before me
this day of 20 9 by this a day of �l 20 4/-7L- by
warn C . M c. Keotw nl
(Name of per ac owledging) (Name of
(Signature of Notary Public- State of Florida) (Signatur . c
Personally Known OR Pro ucedVdentification Person Ily K
Type of Identification Produced on ti o% L GeA ype of den
Commission No. (Seal) I Commission
State of Florida
Mv rn ion Ex�.inlrinq
acknowledging)
of Florida )
CXt�I?it 6: �: >�:. 2020
adlhm Notary Rjb!{S RIA) hers
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