HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI '
ALL APPLICABLE INFO MUST BE COMPLEi to FOR APPLICATION TO BE ACCEPTED
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Date: 3 /9 /�� SCANNED
Number:
BY RECEIVED
• stLucie Cola* MAR 16 2018
Building Permit Application .�201
Planning and Development Services ST. Laic+ - _�+ Perm .-in$
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 CommerI ial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '2 a 1 -- 8,e.,7� 12eeW, i 0; -?'
Legal Description:
Property Tax Tax ID#: 1,4125 " 70/- Da y'S' -O00 - z
Lot No.
Site Plan Name: Block No.
O `
Project Name: i
/
Setbacks Front Back: .33 Right Side: Ivy -Left Side: 9 7
DETAILED DESCRIPTION OF WORK:
Co,vs ��,,,,G � �e � : ��, /zav •� /� 1>1J r rro,
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CONSTRUCTION INFORMATION:
Additional work to be ertormed un ert ispermit-;c ec a apply:
®HVAC Gas Tank Gas Piping _Shutters Windows/Doors
BElectric 0 Plumbing Sprinklers .Generator Roof Roof pitch
Total Sq. Ft of Construction: 303 g S . Ft. of First Floor: �-qr7 S)e
i
Cost of Construction: $ 2 0 I Utilities: _ Sewer 19septic Building Height: . 43 f
.OWNER/LESSEE:
CONTRACTOR:
Name 9 7 q 9 - / 2- 3 ( aet-.L Zve- .
Name: A.V
Company:
Address: C-N
Address: 1/3v5 S, .z„ oL— /Etfk tin.Vre
City: C. J24
to ew
Zip Code: Fax:
City: State:f
'Phone No.
Zip Code: 3fe9p2- Fax: 777- - 5l&' 7- l.3 `/e
Phone No.
E-Mail: — kJ-V tf -C_
�E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: .SY-.Z tf G C 034110 6�4)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
,SUPPLEMENTAL CONSTRUCTION LIEN' LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: /Za "'e
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:/99-q sIJ �:1�•+�Gc2� S�, S 4'-//T
Address:
City: State: Fl,
Zip: 2oaFg Phone: '772- —7T-y- � P-ee
City: State:
Zip: Phone:
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
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.
-- s
as Agent for Owner Signature of Contractor/License Holder
I
STATE OF FLORIDA
COUNTY OF S-V Luc 1 e
The forgoing instrument was acknowledged before me
this C( day of Mo-r Ch 20 i5by
STATE OF FLORID
COUNTY OF -r L UC 1 C
The forgoing instrument was acknowledged before me
this C1 day of MQXch , 20 i$ by
M i t ALr clan ck .Ikon V"t p loin
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Not4rJ Public -State of Florida )
Personally Known OR Produced Identification X
Type of Identification ProducedV(e55(P- 100dg3•p5
C . ••', ",,•, o TONI DAMES -BROWN
7i2
•� -_ ComeMsr�i ff 22181sf J
(Signature of N(o�ary Public- State of Florida )
Personally Known � OR Produced Identification
Type of Identification Produced
ion N50NI JAMES-BROWN t (Seal)
Notary Public - State of Florida
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