HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- BY
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t'
Permit Number: ,1 5�d L1 — O (D
Date:
RECEIVED
Building Permit Application SUN '2 9 1010
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Luelo CountV
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 line ���
,P,ROPOSED .IMP:ROVEM:ENT :LOCATION,
Address: �� �. c� S'�- t= T- P t �2 �-t ► 3'-��i S 1
Legal Description: 061 0'1 ALJ- -r- ±ram-r-P(:�2r Lf 6 r-I�`f
c p 3 S- S-i �� t i=SS '� t-ta4-r-Pc�nr MP oar
Property Tax ID#: \3t)f6 lt\ OO®\- bOo-o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:. Left Side:
D"DESCRIPTION OF WORK
z� S � �Lt� (a- r► . p �-� �� .A 6 F �Lo l_►_.t=-� A t .� �., N -� rn ctta o F a t� ��
ICONSTRUCT7:ON INF.ORMATI;ON
Additional work to Be Dertormed undeFfffis permit- check all that apply:
11HVAC IJ Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
DElectric El Plumbing Sprinklers Generator Roof W �� Roof pitch
Total Sq. Ft of Construction: \ tea, r> S Ft. of First Floor: 1 cx�
Cost of Construction: $ '7 3 � . cow Utilities: _ S.ewer Septic Building Height: �o
-OWN :ER/LESSEE =
CO'NTRACTOR I
'Name e-An- A M 15 2 (Lk V+ r
Name: 'JOHN E MURRAY.,
Address. .�-1 E,�" ''���-A c + S c—
Company:- AMS INC. r'
City: F^ . P t ����� StaterI
Address. 941 $W 8 STREET
Zip Code: 3`V"tS ( Fax: r'\ PNr
City: POMPANO BEACH State: FIL
Phone No. -) - - %-) \S
Zip Code: 33069 Fax: 954-782-0995
E-Mail: r`f ) ls-
Phone No. 800-226-6677
Fill in fee simple Title Holder on next page (if different
E-Mail: maryannp@amsoffla.com
from the Owner listed above)
State or County License: CCCO42787
If value of Construction -is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION-LIMUM NFORMATIO,N;`.
DESIGNER/ENGINEER: _ Not Applicable
Name: JAMES BUSHOUSE
Address: 3300 NE 10 TERRACE APT#24
City: POMPANO BEACH State: FL
Zip: 33064 ,Phone 954-956-2203
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address: QXSc>L-4 s w r ��rp bAvF
City: vim, A,,-, k T__ L_
Zip: Phone:_
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
.Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address: '
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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, 1 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, cons it w' h lender or an attorney before
commencing work or
,r�rding your Notice of Commenceme
rSignature of w� a ntractor as Agent for Owner
t eCont�acfor/L"icens Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF cz o C JJanS�o
COUNTY OF BRowaRD
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of N 5= , 20 VZ by
this day of , 20 \ F by
O �N fvn-rzA7-
JOHNEMURRAY
Name of person making statement
Name of person making statement
Personally Known OR Produced Identificatipg
Personally Known x OR Produced Identification
Type of identification
M— �
Type of Identification
Produced
s a' N z
Produced
w L- Lo
a
� SteCn
Cn
(Signature of.,Plpe�ry Public- State of Florida)
o X $
(Signature of Notary Public- State of Floriid,§)p
a ; ••x., ALAN MILLER
Commissio* * MY COMMISSION # FF 195(abal)
>
* m
' r•••' n ALAN MILLI
Commission No. ���"\ )* MY COMMISSION #
Nr op : ay 5, 2019
�o�d
o�
EXPIRES: May
S �� �rFOF F1.0�` Bonded Thru Budget Notary Services
ii
�rF� F�o�`O Bonded Thru Budget Not
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Rev. 8/2/17