HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-
ALL APPLICABLE. INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:. Permit Number:
-� - . Buildin Permit Application RECEr BY
Pla; Wing and Development,Servi'ces
Building and Code Regulation Division AUG 2 1 7101R
236 1 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial . Reslddii fig.- artmer,
PER, IT APPLICATION FOR:. Pool .inground
PROPOSED IMPROVEMENT LOCATION:
Addr�ss:
Legal; Description: .17
I
Property Tax'ID #: 3 30 d 0 o 0 7 " 6 a 0" �- Lot No: 3n
Site P, an Name: :Block No.
Project Name:
Setba'�'Icks Front /✓ l Back: Right Side: Left:Side: /C
f�
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additionalwork to check all
r.apply:
OHVAC Gas Tank Gas Piping _Shutters Q Windows/Doors .
_Electric L''I PlEl
umbing 0Sprinklers Generator Roof F Roof pitch
Total Sq Ft of -Construction`.. S . Ft of First Floor::
c
Cottof�Construction::$ —� Ut�l> Utilities: Sewer Septic Building Height:
OWN
ER/LESSEE:
CONTRACTOR:
Name�ll�ifiW
Address:
City:.
III
Zip Code:
Phonel
E-Maid
Fill in .fee
from tl
i'iAi�Ie.� �.L uc
Name:
// %OQ /� ✓�i OL,,,O ,Qi�
Company: �-i G �'DN L'�ZL,�I e) 01S
Address: llJ L !Y (/�� . .
City:Ti T�/�� State:
Zip.Code: Fax: qA—. /iG Z'
Phone No.
E-Mail: N1201JL}�J,O�� ;�/!iG
�I%/�`�2G.� State:/.
3 �. fax: eV%
No. i'' 9
h/29 /S/tlLx_. 7/g Cam? Co2,f11_ zo M.
simple Title Holder on next:page (if different:
le Owner listed above)
n
State.or County License:
it vaiue ot. construction is 52500 or more; a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:-
DESIGNER/ENG�ER:
Nary iie:
Address:Fi
City: I
Zip:
_,.. :Not Applicable.
# �V %�I :
MORTGAGE COMPANY:. Not Applicable .
Name:
Address:
&AQ 45't% : C� L u : Lem.
i 6.210 l State: i,
4Z5picc Phone.: N
City: Stater -
Zip: Phone:
FEE SIMPLE
.Name:
Address:
City:
.zip: —.It
TITLE HOLDER: Not Applicable
—
BONDING COMPANY:. _NotApplicable
Name: .
Address:
City:
Phone:
Zip: Phone;
I certithat no work-or,installation has, commenced prior to the issuance of a. permit: .
St. Luc
County makes no representation'that is granting a permit'will authorize the permit holder. to build:the subject.structure
whi.ch,is in conflict with: any applicable Home Owners.Assoaation rules, bylaws or and covenants that may restrict or prohibit such
struct IIIIIIre..Please consult with your. Home Owners Association and review your deed for any restrictions which, may. apply.
In con'siderat'ion 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 Amendment's.
The fo'I owing building permit applications are exempt from undergoing a•full concurrency review: room additions,
access, ry 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 .
befor6 the first inspection. If you intend to obtain financing; con sult'with lender or. an attorney before .
commencing work or recording our. Notice of Commencement. .
ii
s
Signa Ure o Owner%Lessee/Contractor as Agent for Owner tra r Hcen Holder
STAT 0F_FLORIDA STATE OF FLORID
COUNTY OF: �'}. Jam. COUNTY OF • /�+CAl iC
The for oing in was acknowledged before me The for oing instrument was acknowledged before me ..
this % day of 20 Lby this day of : 20 $. by
rLio axd
(Harry f p6Aoknowle*ing") . � . am of person ja*owledging) . / .
11fignature of -Notary Public- State of Florida) (S gnature of Notary Public- State of Florida )
Personally.Known OR Produced ldenti (icatio Personally Known OR Produced Identi 'cation -
Type of :
Identification -Produced Type of Idenfification Produced �+ . _ _.
Commission No. P+0
P� •. '"Y°° ARA d*&NANDEZ.
FARA(j}iERNANDEZ Commission No: °�.......,'•,MYCOMMISSION #FF172419.__[ •€ MY COMMISSION #FF172419
oQ;`ReVl cU 07/15/20g8 p153 fl0fidallotaryService.com . (407) 39MI53 FloridallotaryService:com
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