HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: lla._ 0
' RECEIVED
Building Permit Application DEC ® .
Planning and Development Services w 2011
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St• 'Lucie County,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ry� FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,PROPOSED, IMPROVEMENT LOCATION:
Address' /-
Legal Description: SP� �S 1 L'� 4s 1��- (l� S
Property Tax ID #: I - l Qo- 00 0
Site Plan Name:
Project Name:�%i��t�
Setbacks Front Back: Right Side: Left Side: _
D'ETAI,LED .DE''SCRI PTION :OF- W:QRK:':
�a G0[Jl1S ��S®O�U��/ OYl IllO
Lot No.
Block No.
vIV C�
CON$TRU:CTI,ON [N,FORMATfO,N
Additional work to be performed under this permit - cFieck all apply:
1_1HVAC Gas Tank E]Gas Piping _ Shutters Windows/Doors
® Electric Plumbing Sprinklers Generator E Roof Roof pitch
Total Sq. Ft of Construction: 1-7 0 5' S . Ft. of First Floor: _
Cost of Construction: $ /0 Utilities: 11 Sewer E]Septic
Building Height:
OWNER/LES:SEE. ` :,
CONTRACTOR: I
Name �� y G[ (T`L
Name: JOHN E MURRAY,-
Address i,COCfO 1'1i0 C
Company: AMS INC.
Address: 941 SW 8 .STREET
City: F0 Yf I erc�_- State: Ff-
Zip Code: J?�i�'/�� Fax:
City: POMPANO BEACH State- FL
Phone No. 7 i;?. - q(P " q3q
Zip Code: 33069 Fax: 954-782-0995
Thone No. 800-226-6677
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: maryannp@amsoffla.com
from the Owner listed above)
State or County License: CCC042787
If value of construction- is $2500 or more, a RECORDED Notice of Commencement is requireo.
SUPPLEMENTAL CQNSTRUCTI.ON LIEN LAW hNF,ORMAI'ION} _ '!
DESIGNER/ENGINEER: -
Not Applicably
MORTGAGE COMPANY:
Not Applicable
Name: JAMEs BUSHOUSE
Name:
Address:330ONE10TERRACE APT#24
Address:
City: POMPANO BEACH
State: FL I „
City:
State:
Zip: 33064 Phone 954-95&2203
I
Zip: Phone:
FEE SIMPLE -TITLE HOLDER: /
Not Applicable
BONDING COMPANY:
,/ Not Applicable
Name;
Name:
Address:
I
Address: J
City:
I
City:
Zip: Phone:
Zip: Phone: I
I
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 ancovenants 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 Godes and St. Lucie County Amendments.
The following building permit applications are exempt from
accessory structures, swimming pools, fences, walls, signs,
WARNING TO OWNER: Your failure to Record a No'
improvements to your property. A Notice of Comi
before the first inspection 11f�iyou intend to obtain
commencine work or re7or ne vour Notice of Coi
going a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
:e of Commencement may result in your paying twice for
encement must be recorded and posted on the jobsite
nancirig, consult with lender or an attorney before
mencement.
t� -
Z
-Signature
of t Lesse Contractor as Agent for OwnPSTAT
-_
Co ,, r"ctor/License Holder
STATE OF FLORA
FLORIDA
COUNTY OF Y-0
COUNTY OF BRowAm
The forgoing instrumen was acknowledged before me
The forgoing instrument w s acknowledged before me
aE by
thisI (Zday of DV _,_, 20,2 by
this day of /QbV , 20J'7
,-To A r, e , U., r `w
JOHN E MURRAY
Name of person making statement
Name of person making statement
Personally Known V OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification
Type of Identification
Produced
UA
Produced
lQqc�
(signature gf Pubes orida)
(Signature of N ' rYP�blic- State of Flori
M P
* MY COMMISSION # FF 227587
Commissii� F S:Ma 5,2019 (Seal)
0�� .. ,%&,�
COMMISSION
Commission No. MY COMMISSION#F� 788581
UI
5,
qr Bonded Thru Budget Notary Services
goFf�A
ES: May 5
"�gpO? badodThrueudgotNoteryServices
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
o2�
DATE.
COMPLETED
Rev. 8/2/17