HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL AP' LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l Q C
Date: Permit Number:
Building Permit Application �u�l�� A�6 3;mz018
Planni g and Development Services BQ'f�p
Building g and Code Regulation Division S `acl artmenr
2300 'rginia Avenue, Fort Pierce FL 34982 county
Phon f: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP' SED IMPROVEMENT LOCATION: R '.
Addres I: —7 D I S 351 St
Legal D' scription: `P61IM VI S 1 A ST_S 2 L* L,Q"q Lf,S [A/LY 15D Ff
n .nii! I /\-I- I A- We C I A I I \/ I C E
Prope Tax ID #: lL �} D [l O I �V 17 DDO- 1 Lot No.
Site Plan Name: Block No.
Project ame:
Setbac ' s Front Back: Right Side: Left Side:
DETA t1b DESCRIPTION OFWORK:m
l Il'a ✓ ke'-wf L1.5 l r-6 mu ) e h t C) C r-1 CrI t rile C
CONS;k RUCTION'IN'FORMATIaN .
nclitid;a work to be nertormed under this permit - check all that apply:
� AC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total S(I.
I Ft of Construction: � �j�p� J S . Ft. of First Floor: _
Cost of Construction: $ I " l "1 0 Utilities: Sewer l:] Septic
1111
Building Height:
01NN
R%LESSEE.: ;a
CONTRACTOR:
Name
_
II
Name: A M if, (M m Il d i
: _W)35 {� I�f InmP, td
Company: ( i
Addres
n StateMp
City:omn
Address: S S
Zip Co
e: 'Ll (Qaz Fax:
City: 60a W t9 <-W k State:
Phone
40.
Zip Code: 33y Fax:
E-Mail
Phone No. Sb 1 5-7
e simple Title Holder on next page (if different
.Fill in f
E-Mail: S tA
91CCJ!�2
from t
,ip Owner listed above)
State or County License:
If value §f construction is $2500 or more, a RECORDED Notice of Commencement is required.
So0,0
! MENTAL CONSTRUCTION LIEN LAIN INFORMATION
DESIG
Name:
ER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Addre
Address:
s:
City:
State:
City: State:
Zip:
'I Phone:
Zip: Phone:
FEE SI
A PLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name
1
Name:
Add re!
s:
Address:
City:
City:
Phone:
Zip: Phone:
Zip:
I certiNll�that no work or installation has commenced prior to the issuance of a permit.
St. Luci County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which islin 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 considerationd of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accAance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The foll wing building permit applications are exempt from undergoing a full concurrency review: room additions,
accesso ;I structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN1,NG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impro 'ements 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
comm ncine work orx-,ecordine vour Notice of Commencement.
I . — u— S
Signatuife of Own er/L see/ ontractor as Agent for Owner Signature of Contractor Li erfse Holder
STATEIOF FLORI A PaLM ieA Cl-f STATE OF FLORIDA
'COLIN OF COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 21 day of JU L\J 20 Eby this ZIP day of J Uly 20 Ig by
1 JAM IE F• G4L-101DI J4M16-JLlrnlbl
(Name 6f person acknowledging) (Name of person acknowledging)
Signat' re of Notary Public- State of FI i a) (Sig ture of Notary Public- Sta I rid
Person ly Known OR Pro\G� ���n Personally Known O_ �ation
Type of dentification Produced �� 5 0 P/// Type of Identification Wdur,��yO�Mis$�ON�• ....., .
•' e,�,,� • ,, o4 :'��' �'
11
Fyr
'o =
Commi 'f ion No. _� : •�y�tsl3edl)r�O•; s Commission No.
• ,moo• - •
O .offffG
G14
ReVid 07/15/2014 ' 9 y? : *� i �,o �,�°ed thN
�GGB
�idadtht�...�g�y' P_ �i�/��� �;c
Unders:-*'90 �
�Y"�I UTLE
REVIE
S
FRONT
� �
PLANS
VEGETATION
MANGROVE
COUNTER
REVI '
��O!RVISOR
REVIEW
-REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPEFTE
INITIA