HomeMy WebLinkAboutBuilding Permit Application- "A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • 2 Permit Number: C7S�,
FRECEIVED
Building Permit Application JUL 2 7 2017
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: a
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)00/IVC IqN #9
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Legal Description:
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40T 27
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/5/25- N67 : /q97
Property Tax ID #: 1:21' Lot No. Z 7
Site Plan Name: 06 lV (.Jl CC. t A M S Block No.
Project Name: 'Q O N ��� L 14 PA, 5
Setbacks Front 2- Back: — Right Side: — Left Side: — J�e� S IT C 1°C r7 �✓
DETAILED DESCRIPTION OF WORK:
JWf-4AtI A-i/DUB 0� A
5 iA/L.,0 - 9 Y 60-NC,12,4 +O/Z
CONSTRUCTION INFORMATION:
Additions wor to a oe orme un er t is permit- check all =apply:
jj11HVAC U Gas Tank
Il Iectric 0 Plumbing
3as Piping "Shutters
Sprinklers Iy 1'Generator
aWindows/Doors
Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: ti/A
Cost of Construction: $ • b O Utilities:(USewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:,
Name 00" /ry I LLi A M 5
Name: 60 Y S MOV IZ E)
Address: �y U PC I IVC 1 ii w A CT
City: f'r;&T PULcCE, State: 0-
Zip Code: �3Ll951 Fax:
Company: S. S . M0O&C CSCOCTIZ K, G LC
Address: 21g? C,9J9/Z r3o2 OR
City:ye'" 1�r_'Ackl State: L
Phone No. 772-- 4166 - 2831
Zip Code: At 32 960 Fax: 7*7 Z "77'1-Z qV
E-Mail:
Phone Now 77 Z - .569 -06W
E-Mail: !' VS 685N 67 CO im C4.0 i, NE
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: �_C /306 6! Z 2
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,SUPPLEMENTAL,CONSTRU.CTION LIEN LAW
NGINEER: ✓ Not Applica
Name:
Address:
City: State
Zip: Phone:
FEE SIMPLE TITLE HOLDER: v Not Applicable
Name:
Address:
City:
Zip: Phone:
rr►ouaJ®LfJa
MORTGAGE COMPANY: —,"'Not Applicable
Name:
Address:
City: -.<. --State:
Zip: Phone:
BONDING COMPANY: d 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 andcovenantsthat 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.
Signature 6f Owner/Lessee/ u ra toms enuEAxgo —er oS
__ - C-ift cfemiLicense I
STATE OF FLORID - STATE OF FLORIDA
COUNTY OF �a.,i - IJL COUNTY OF ,/�N�
The forgoing instruMM pt as acknowledged before me
this;Aklay of 20/Zby
1
(Name of person acknowledging)
(Signature of Notary Public- St of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
WILLIAM SURGEON
Commission No. JAENt A&MkY PUBLIC
STATE OF FLORIDA
Revised 07/15/2014 '4ffW Expires 8/28/2017
The forprig instrumQts acknowledged before me
this of 20 /7 by
(Name of person acknowledging)
(Signature of Notary Public- Sta of Florida )
Personally Known / OR Produced Identification
Type of Identification Produced
Commission No. WILL��URGEON
A , NOTARY PUBLIC
Comm# FF049453
Expires 8/28/9017
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