HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y r
Date: 101 Q_� I 1 -1 Permit Number:
Building Permit Application OCT 3 0 2017
Planning and Development Services
Building and Code Regulation Division pERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Luci county, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATIO'N:;
Address: rl30LA �Le-
n-
Legal Description: LdT 1 3/O GeG I4
norf -1
Property Tax ID #: 6 �510 0�/S' 6.00 's— Lot No._�
Site Plan Name: Block No. A_
Project Name:
Setbacks Front I Back: 1�-Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
,30 30 x 12 �nC�o�e S�ee,l 10 1 c� �9 01n
qa(lq &-& �;qragt
V / N 6 LIs�r
CONSTRUCTION INFORMATION'
Haaitionai worK to ne errormea unaer tnis permit - cnecK ail apply:
E1HVAC _ Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
I, ❑ Electric 0 Plumbing' []Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Qo S . Ft. of First Floor: qoo
Cost of Construction: $ _�� Utilities: KSewer ❑Septic Building Height: vZ
OWN:f R/LESSEE:
CONTRACTOR:
Name t Ori( 4TLh-(OP03t •
Name:
,Address:1304 I� 9� j�c2+� 12 D •
City. � - p«ce State: R-
'�ZipCode: .3 t fG5 I Fax:
honeNo. 1 "1 E'� - ''J� d<<
IE-Mail l DAD1��\ S A-2U(__4&InP-f C6W
-Company: aY 1��fe,
Address:
City: State:��
Zip Code: Fax: 2)
Phone No.
E-Mail:
ccl
Bill in fee simple Title Holder on next page ( if different
fl om the Owner listed above) 0ILA3 CV_X-
State or County License: C-_R)C")�LMqq6
If, value of., construction is $2500-or more, a..RECORDED Notice of commencement is required.
nO qlumbl'N noe[eH�i(__
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: lir-'ranee'rivia
Addr s:
City: State: H.
Zip: —,-'>�-JaQ Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: 0VkDn4e_r
Address:
City:
Zip: Phone:
MORTGAGE COVIPiffiY: _ Not Applicable
Name: �" %54?-eJI&
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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: 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.
ctor as Agent for Owner
STATE OF FLO!?"/�
COUNTY OF
The for ing instru ent ias acknowledged before me
thisay of 20by
(Nam �of person acknowledging )
afure of Notary Public- State of Florida
Personally Known L/ OR Produced Identification
Type of Identification Produced
Commission No.
PAMELA G. COLEMAN
Revised 07/15/20'1 �?:' MyPornmissi n # FF 095059 18
f 5�> CJ
Y
� s
Signature of Con ctor/License Holder
STATE OF FLORA Ih
COUNTY OF
The forgoing instrument was acknowledged before me
this -Q' day of 20 1-1 by
I V)M()� N"rr
(Name of person acknowledgin )
ro aA L m vQe D��
(Signature of Notary Public- State of Florida )
Personally Known OucR Produced Identification
Type of Identification r ed
on No. cJ 4` A
CECILIA M WELSH
EXPIRES May 29, 2021
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