HomeMy WebLinkAboutBuilding Permit Application (2)ALL APPLICABLE INFO MUST BE COMPMWOR APPLICATION TO BE ACCEPTElb W W
Date: / - ` l I I^ �� Permit Number: 170 o0 y '
t�.
Planning and Development Services - JAN 0 5 2017
Building -and Code Regulation Division
2300 VirginiaAvenue, Fort Pierce FL34982
Phone: t772) 4.62-1553 Fax;. (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To, Select from dropbox, click arrow at, the end of line
PROPOSED I ROVEMENT LOCATION;
Address: KWA Vlr�S!,A - �Wp
Legal Description: 111 - �4(LIC�V �S l3- '1'i 3� 0., 35 p 'tl1A0f" _P A S YiI 060
'PropertyTaxID#: Lot No.
Site Plan Name: 'Block
'Block No.
Project Name: AAA Q 11-S -PI �i
Setbacks Front Badc . Right Side: Left Side:
;DETAILED,I)ESCRIPTfON OF;I /ORK; 5:
NA I L- IM-Aal- -�PjvN-i l vaak tQ J W -ALL, 5l•&11Y4_fb0V -
N:
P uulL V11 vvv� n ¢v uc ci wlru ICU unucl LLItJ �;JC191111-LIICLK C111 dlllJly:
L�HV' C —.Gas Tank RGas Piping _Shutters LiWindows/Doors
Electric D Plumbing[]Sprinklers
]S rinklers Generator Roof Roof itch.
L�J P _ P
Total Sq. Ft of. Construction: 6. i . . � 5 . Ft. of First Floor--
,.
Cost of Construction: $ �(-0..0_.10 Utilities: _ Sewer Septic Buildingl;eight:.
01JVNER/LESSEE
CONTRACTOR,:
Name U
Name W 056(L
Company: e
Address: !M MA - ew__)��
City:. State: �(i
Address: A
Zip Code: Fax:
city:, ��, l ' State:L
Phone No.CJ94- (04U - &ZO d
zip Code: 32/00-0 Fax:
E-Mail:
Phone No. GI SI L
Fill in fee sirMple Title Holder on next page (if different
E-Mail: Sl Qos - P, A o L • �� V l
from the'Owner listed above)'
State or County' License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
01�
ib Q-RIl '�7tj &
I
DESI,GN.ER/-9NGjNEER-
Not Applicable
MORTGAGE COMPANY:'
of Appfica'b1'e
m V ' -1 AZ
Name.
Name: ,
Address.-'
Address:
City.: 'A 1AM71
Siatel mPt-
City-
-State:;
,Zip-i Phone:
—
Zip: Phone:'
Phone:
FEE SIMPLE -TITLE "OLDER:
ot.Applicable
BONDING, COMPANYi.
--Nt5f'A-I "licabig
Applicable
Name:
Name:
Address-
Address:
City:
city:
Zip: Phone:
Zip:
I certify that no work or installation, has_ qqmmence,. prior to the issuance of -a permit,
St.. Lucie C' !e..,oupt Iderto,buildthe,subjectst structure ,y..rha- es no representation that' is granting a permit will, authofizethe,p.ermit'ho I ru u re
which.s intonflict with- any applicable Home"Owners,Associatlon rules, bylaws or -and covenahts.that may.. restrict or prohibit such
structure: Oleas& consult1with, your Home Owners, Association and reviewyour J�ee your7d' d for any restrictions which may. a PP Of
y-
In consideration of 'the granting, of this requested permit; I,do hereby agree, that I will, in. a [I respects, perform; the Work'
in.accordande with -the approved plans,_the Florida Building Codes and St. Lucie County
Amendments.
The following building perrrflt,applieations-are exempt,from,undergoinga full cQncurrencyrdview: room,additibirl's,
accessory structures, swimming poolsjences, walls, signs, screen rooms anda(cpssbiry uses to another non4esidential:use
WARN INGICY-OWN ER-.,Your.A fahurd.,toAecord a Notice of Commencement may result in your paying twice for -
improvements to your property. Notice of,com,meric'ement rhilst,berecoeded arid.Aosteid on the jbbsitO
the fi before thrst. inspection. If you intend to obtain finanting, consult with tender or an attorney before
commencing "work or,riaco.rding�.vour'NijtitO.of Commencement._
Signature of 0wrier/Lpssee/Contractor as Agent for owner
STATE OF, FLORIDA- STATE OF FLORIDA
COUNTY OF COUNTY OF 77
The forgoing. instrument was acknowledged before-ime Theforgo.itig instrument was acknowledged before me
this. VS day of 20 1 Wby this � day'df :DjjT== 20 f00 _.by
"to a -me of'person acknowledging) (Name
Si ature. of Notary Public --State, of Florida
Personally Known OR Produced Identification Personal
--'�121 L?4�i
Type of Identification Produced.-Pt,DC, I At - Type, of I
Jm"*A!Rd'd
'j
Commission No. cn(-, of (.p ARYPUBLIC Commiss
STATE OF FLORIDA
Revise.4 07/1UZ0,14 -mvFW E*res 7t27r2=
OWARD S
fduceclExpires Sep 15. 2017
Commission # FF 021608
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