HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa3y
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: sj, to '"7 �� S +ermlt %� Number: ~ V (0n 2
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Building Permit Application JUN 0 9 20-17
Planning and Development Services FER1.4�'
Building and Code Regufotion Division St. LiJc' C;Qunt�r, FL
23W 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: O d ��' p� e r u Ll
Legal Description: C_- Y - l L% r- 3 7 - 3
Property Tax ID #: �__Z S"/ c7,_�,x 00_-- -b c� r - -- 6 a O - L Lot No. % Site Plan Name: a w t„6: c jr�, rj0,�r[ Block No.
Project Name: Y' N n uJ
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
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CONSTRUCTION INFORMATION -
Additional work o be Berlormedunder this permit- ce all apply:
&HVAC Gas Tank DGas Piping _ Shutters Windows/Doors
Electric 4— Plumbing ❑Sprinklers U Generator Roof ill Z Roof pitch
Total Sq. Ft of Construction: yr 7 S F S . Ft. of First Floor: Z 3 SI S F
Cost of Construction: $ i r / O do Utilities:YQ Sewer Septic Building Height: 1 � 6 It
OWNER/LESSEE:
CONTRACTOR:
Name 9us5 4_ &rNOA utaW- s`
Name:
Address: Yd g dg/l.�i s Pi.c�_r'
Company: JDAS ricEU / EGE at»y0459—
City: 4064-1- <Ir 6,.,e.,I FC* State: FL.
Address: 91s sF bC tgludl 444
Zip Code: 3 y!`S (o Fax:
City: r,= UA= State: ILL
Phone No. 7 7a- U!6 r - ((
Zip Code: -4�!f Y Fax:777d, • d%-? • XZ 70
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Phone No. g Lo
Fill in fee simple Title Holder on next page ( If different
E-Mail: ' a/
from the Owner listed above)
State or County License: G U
Log—i O
it value or construction is ;izsuu or more, a Rtcwsutu Notice of commencement Is required.
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DESIGNER ENGINEER:
` Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address:
Address:
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:
1 certify that no work or Installation has commenced prior to the Issuance of a permit.
St. Luc a County make $ no represerr%�tation that is granting a �ermit will authorize the permit holderto build the subject structure
which sin conflict with anYY pplicable Home Owners Assoctation rules, bylaws or ar�d covenants that may reprict or prohibit such
structure. Please consult wlt� 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 fuilding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full cancurrency review: room additions,
accessory structures, swimining'pools, fences, wails, signs,, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your (allure 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
as 0
V 1, 1 VV
STATE OF FLORIDA STATE OF FL RIDA
COUNTY OF � _t - �—yKck t- COUNTY OF LA-C-t
Thergoing ins ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 i2by this day of 20 k'1 by
(Name of person acknowledging } (Name of person bcknowledging }
&'&__ _'
(Signature f Nota bpc- State of Florida } (Signatur f Nota ublic-State of Florida)
Personally Known_ OR Produced Identification
Type of Identifi�Ien {hsl OR -
Commission
Revised 07/15/2014
MYCOMMISSIRMf 941245
'RPiRES: December 25, 2019
Mad Thm Notery.Pubric Underwdters
Personally Known � OR Produced Identification
Type of Identiff •'--' '.--A - -
..........
.v •..
:$NANCYB.DALTON
Commission NA a.� MYCOMMISSION(SM1245
EXPIRES: December 25, 2019
Bonded Thor Notary Pubrw Underwriters
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