HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBY t. 1
At N name rmq*
`3
AIL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED v
ate:
Permit Number:
RECEIVED
Building Permit Application AUG 3 01017
Manning and Development Services Permitting Department
luilding and Code Regulation Division St. Lucie County
P00 Virginia Avenue, Fort Pierce FL 34982
hone: (772) 462-1553 Fax: (772) 462-1578 Commercial �_ Residential
RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PiROPOSED;IMPROVEWIENTLOCATLON t ' ,'. :..
.d►ess Z Sao N F/u/�/ /�1.A , P��i�G6 �L 3y 9 �9
Legal Description:
III
0000 —Ooo - Z Lot No.
e Plan Name:
S�lI
Block No.
P oject Name:
tbacks Front Back: Right Side: Left Side:
_DETAfLED DESCRIPTION OF WORK .;`
Irt"y - j
I
V
i
CONSTRUCTION �IIVFORMAT)ON -"
Additional work to be Ilerrormed un ertis permit — check al apply:
IIHVAC. Gas Tank []Gas Piping Shutters
_ Windows/Doors
Electric 0 Plumbing Sprinklers E]
JI(otal
Generator Roof Roof pitch
Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 6 00 Utilities: Sewer Septic Building Height:
0.1GUNER/LEtSSEE
--
CO R
NTRACTO
ruame 6G& M.&W 4 CyA7b ASSA)
Iddress•
]Name: t6 s'r� zlzt L�
21700 Al HWy A14 JW
Company: —%�� DVLS Z h4jzf25
i
ity:!" /�/��� State: �L'
Address: .S b 3 �-D I/ "
ipCode• 3ygy9 Fax:
�i
City: ef2D be- � State:
i
Phone No. 772 - 6a - 30
Zip Code: - �,� to b Fax: �—
E-MaiL•_
Phone No. r7,7A — q%3^ `1L oZS'
j r,
dill in fee simple Title Holder on next page (if different
E-Mail: _ I �L _r_ l%UJ 15 Ga M
`
rom the Owner listed above) =+
State or County License: -- C ec /1*5 LlL
I
► value of construction is $2500 or more, a RECORDED Notice of Commencement is required. fi
=r
SUPPLEMENTAL CONSTRUCTION' L'IEN'LAW INFORMATIgjV M`
4,
ESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Vame: Name:
ddress: Address:
it
State: City: State:
ip: Phone Zip: Phone:
SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
:ertify that no work or installation has commenced prior to the issuance of a permit.
Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
iich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ucture. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
ie following building permit applications are exempt from undergoing a full concurrency review: room additions,
cessorystructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
►ARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
iprovements to your property. A Notice of Commencement must be recorded and posted on the jobsite
!fore the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Of
STATE OF FLORIDA
COUNTY OF
as Agent for Owner k;I,sSignature of
L 61 C /Z
The for oing instrument was acknowledged before me
this day of /BUG 26yby
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced 1�, L . � � �s e0)��
Holder
'ATE OF FLORIDA
)UNTY OF Say'
forgoing instrument was acknowledged before me
6 day of N/7l . 20Lk by
&hAzC- %r✓'z L
Name of person making statement
,onally Known OR Produced Identification
s of Identification
Si ur Notary Public- State of F ri� -ire o otary Public- State of Florida) Nota
ry PublicS t * a OF
� :`35 �3 James Pedra�?mmtssio No. My Commissiogbttl�iOn O.�Sc'Sat w Expires 04102/2 222 �2 02 2�; t".
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE gold�i�
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW `��fi
,ATE y = a
ECEIVED o.rn z ro
,ATE
OMPLETED *+
�. 8/2/17 m N ro
Cn V Q Q