HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t'
Date: �� —7 Permit Number:
7
^� Building Permit Application
Planning and Development Services JUN 2 2 20113
Building and Code Regulation Division PER10P1NG
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lu 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
LPROPOSED IMPROVEMENT LOCATION:
Address: J q U I TI l n ro" P 11
��. LW9 R 3q 9 E 2-.
Legal Description:
Property Tax ID #: 3q 1 L4 ' Sb I " (I 01 — OSD '- Lot No. —_
Site Plan Name: Block No. 13
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
$IM l cC a 3 LI' ,e 3(O' Ca-i-p o r'- tulj-in v u-+v, r r, L f, fZo o f
N. r) Co n Crt+f_,,
CONSTRUCTION INFORMATION.:
Additional work to be performed under t is permit- check
11HVAC r]Gas Piping
a 11 t= apply:
LJ Shutters
Q Windows/Doors
Gas Tank
U Electric 0 Plumbing
[]Sprinklers
El Generator
Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
11 0
Building Height:
Cost of Construction: $
Utilities:
Sewer Septic
OWNER/LESSEE:
CONTRACTOR:
Name A
Name:
l d, • �F
Address: �LL40I M l hn 12d
Company:
1
AS on
City: Por+ S+. bu C 1 Z State: -
Address: .3S
( S
9-
Zip Code: Syr S2 Fax:
City:
le-ew
Stater
Phone No. 139S)14'61— S S-1 I
Zip Code:
4qq S I
Fax: qZ (p
E-Mail j asw h am on Q? yrna" (• Co',
Phone No.
(117-) 343.- 0i3 oS
Fill in fee simple Title Holder on next page (if different
E-Mail: L"
U.0.1t ilh
t7 1� LL C S d � • ���'
from the Owner listed above)
State or County License:
(,IBC 2S1� 3`i
if value of construction is.5z5ou or more, a REcoRUEo Notice or commencement is regwrea.
10
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: 6D8 Dun 1eA
Name: lnJ % R
Addres : >° aniCS
fa&
Address:
City: y
State: IF ,
City: State:
Zip: 321'V-1 P one:
- Lo
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: LJ
Not Applicable
BONDING COMPANY: Not Applicable
Name: I�l
Address:
Address:
City:
City:
Zip: Phone:
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 toy r property. A Notice of Commencement must be recorde4 and posted on the jobsite
before the first irKprection. If you intend to obtain financing, consult with len er or an attorney before
commencing w r or recording vour Notice of Commencement.
sign ?"I"
of uwnerpessee/contracrer as Agent Tor uwner brgnaiuge or t_ontrauopucense rIMUM
STATE OF FLORIDA P
STATE OF FLORIDA r
COUNTYOF M 1,14 eq COUNTY OF T I
The for oing inst-rurpent was acknowledged b fore me
thi day of 20 by
;Name of person acknowledging)
Personally
Type of Idi
Commission No.
Revised 07/15/2014•
State of Florida
The forgoing nstru ent was acknowledged before me
i
this a day of , 20 `jT� by
Da_ue.
(Name of person acknowledging)
-,Type of
My Comm. ExiPlres Dec 1, 2017 Commission
Cornn( sQ�jd # FF C69924
Banded Through National Not Assn.
State of Florida )
My Comm. � p�ire,� Dec 1, 2017 ",.
Commiss F 069924 =
fonded Through National Notary Assn... y;
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