HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: `o �t - v
--1111-MMANIMAME JUN 22
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Building Permit Application
Planning and Development Services P��
St. Lucie Cc;
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: S-7 ()t% PM(" Onvb Tort- elea-e . f-e. 34 02
Legal Description: VZUff 1.1 VtI & tMICS U AH Ob B UC L02 WE S I MftP N J/;
Joe soy_ (�3 0) /�
Property Tax ID #: 3 Li OL L0 �"I - 03103 (] D0 - 4 Lot No.
IT -
Site Plan Name: Block No. (P cZ
Project Name:
Setbacks Front e, Back: Right Side: N Left Side:
DETAILED DESCRIPTION OF WORK:
?2 V-.0 V- Q, "t, St" 10 `x. 2-Le" SCA zan r Dorv% Olno� raw l oC I n
lv_a.'* lbca--fi Dn .
CONSTRUCTION INFORMATION:
nuu1L1u"a1 wvrK zv Ue envrmeu unuCr tms permu — 6iiCCK du apply:
13HVAC Gas Tank []Gas Piping Shutters ❑ Windows/Doors
11 Electric 0 Plumbing ❑ L-�.I Sprinklers _ Generator F]Roof Roof pitch
Total Sq. Ft of Construction: J e O S S . Ft. of First Floor:
Cost of Construction: $ �5; 2- d O Utilities: Sewer E]Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name �00_r1 L. R&UMYJL' 12IX
Name: IWO r
m1wof
Address: D q- 90AM On vs°,
Company: A Q Ua-t
-1- 0w)S ue:h an
i lLl
City: FO%Pie(y State: F�(-
Address: ?S
�='
Zip Code: Fax:
City: le
State:
Phone No. 1-12 ) 4 toB - qa 1(P
Zip Code: S4,701
Fax: -Y7bg(01 _,?038
E-Mail:
Phone No. t -i -i -L)
343 - o a o S7
Fill in fee simple Title Holder on next page ( if different
E-Mail: PrA GLL J i i-U
010, i3e,( &U:ff1 - r) of
from the owner listed above)
State or County License: C ea ()-SY 731
If value of construction is $2500 or more, a RECORDED Notice c Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: e fi . D U.^ (-ffo,
Address: IS-13 MVCU- ifS P d4_C2
City: V i 11 S State: i L,
Zip: Rlirg hone: - 'f
FEE SIMPLE TITLE HOLDER: VNot Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _ of 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.)f you intend to obtain financing, consult with le,�er or an attorney before
commencine work or reccddrdine vour Notice of Commencement. �r
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF c ( .� el ICOUNTYOF_5At,, 011
fnwning instrurpent was acknowledged? me The forgoing instru ent was acknowledged before me
this, day of 20 by this 9Bday of 20 q_ by
boil','"Utl bye �Qot
(Name of person acknowledging) (Name of person acknowledging)
(Signat a Pub �C- State of Florida) (Signature gMfar`�'Puffi State of Florida )
5' .. _ ...x__...r-_.F,,....._.....n-..,.;..,.,...�;.,, .ytr^*.-« ♦ c+. l � I. T - r ..• — SA4...m"h..,:,..r..-. ... .
�' � 5 Personal) Kno S :c��i,�r,�' R Produ cfi[dentification A
Personally Know �,,,r ,AR ProducgdJ�otffiEi�ltld"J" y oA
Type of ldentifica of -fit ntary pub - State Jflo�fd3"' '' ` `' Type of ldentifie ' s9d Notary Pubic, a r,. Flonda
- My Comm. Expires Dec 1, 2017` � ,3; c My COMM uec 1,2017
Commission No: : Commis(Seal) FF 069924 Commission No.: cc (Sealy 069924•s,
°Pry c,j .Bonded Through National Notary Assn. ?; ,' B� National No ary;Assn.
Revised 07/15/2014 • I ..
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