HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: c2- 1-P 17 Permit Number: /� T / � a ' L
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Building Permit Application DEC 16 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 lineIT
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Address: 6165 91I AMAJ R�uEt -bf-T 067 — 6047- / 1- 3 5190'a
Legal Description: I ' 6Ifo rJ da 6FS t/a OF S'ht bF !� 'aD ,AC pFeybOT OT'3L WD aLL l,Wr LoT3 I.Y'r- 'gF0F OF
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Property Tax ID #: 3g01- `, - OLD - CJI o-
Site Plan Name: oateyx.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Lot No. a.
Block No.
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Additional work to be e armed under this permit — cnecK an tna apply:
0HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Z 000 SF 44"_ S . Ft. of First Floor:
Cost of Construction: $ a(oOUtilities: Sewer Septic Building Height: ZZ
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Name ,-'-r ri A - alyonDs LT
Address:_61d5:
Name: �izw�� S • yv
Company: )1
Address: 1644 SE S. IL)rEYl7 y�i exir
City: �D7Li ST LL1 State:
City 401-17 i T. Ccc State: FL-
Zip Code: S«Z�a2 Fax:
PhoneNo.`17a-a60-8it/9
Zip Code: c3W15a Fax: -Z7a--335-
E-Mail:
Phone No. 'rf '7a - �i5- 9GSo
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: �b, L L M P C141?b-17/TC Ta Fkng ,60> -
State or County License:
if value of construction is $2500 or more, a RecoKutu Notice oT Lommencemeni rs regurreu.
-1
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
tate:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
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 to your property. A Notice of Commencement must be recorded and posted on the jobsite
beforgA�he first inspection. If you intend to obtain financing, consult with lender or an attorney before
comrvieAc(nR work or ras=00R vour Notice of Commencement. ,
_ Signature of Owner/
ature
STATE OF FLORIDA STATE OF FLORIDA
COUNTY 6F 6T L..CZCa� 9-- 1 COUNTY OF , IT LLl C17&
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_15�h day of bexdw&4 20 aby this 501day of VV6_ e1n1VX 120 17 by
(Name of person acknowledging) (Name of person acknowledging)
U4.L_ (Ymaai�k
(Signatur6 of Notary Pub/li - State o Iorida) [Signat0e of NotaryPublic- Sta a of Florida )
Personally Known +Y OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
, VAY AI/0DENISE LEMAY
Pp��, r° •• ••• �'� ®F.l`II9ELgMAY
Commission No.W 077376 'e@$YYCOMMISSION#GG0 Commission No. 99 077,37(> ? , et r)coMMlssloN#GG0773
d EXPIRES: March 23, 202
SM.", - . . � _ EXPIRES: March 23. 2021
Revised 07/15/2014
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