HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
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INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 �1
Permit Number: i6V(' ���
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Building Pe,'mit Application
Planning and Development Services
Building !and Code Regulation Division
V• ' • A Fort Pierce FL 34982
RECEIVED
SEP 2q 2010 ez
Permitting Department ��/
5t. Luclq Cownty :60
2300 ►rg►n►a venue,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from d'opbox, click here
PROPO ED IMPROVEMENT LCATION O:
II - ff ;,.
Address: l 1 .,,5 =rn alP �v, F'F I Picrce� R if
Legal Description: Fii-a,"
PropertTax ID #: l311- 7yf -oo3 ro `off �'� Lot No.
y
Site Plan Klame: Block No.
Project Name:
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Setbacksl Front Back: Right Side: Left Side:
DETAIi.EQQESCRIPTIONyIOF:'WO'RK
Recal e�• i�'ld6I..�e �Owte.:� `U��ly csev� L't d"h 5% r[ f"l iVlc.vi�fan�
Y /.
1730 �
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O,NSTRUCTION INFORMATION:
ition i wor to e e orme un er t is permit - c l ec a app y:
HVAC Gas Tank ❑Gas Piping; _ Shutters Q Windows/Doors
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Electric 0 Plumbing Sprinklers, Generator Roof
Total Sq. Ft of Construction: 0176 l S . Ft. of First Floor:
Cost of Construction: $ 7,5 a7. Oa Uti ities:sewer Septic Building Height: 15'
OWNERf LESSEE 1
.,y
CONTRACTOR;,
Name Lo s o�
Address: I $ S/ i war- w.
Name: Rebecca J. Mays
Comfort Cover CSystems, Inc
Company: y
Address: 711 Turner St.
City:
Zip Code
Phone No.
C r« State: Cc-
771- 3 S 9 - /fG.33
City: Clearwater State: FL
Zip Code: 33756 Fax: 727-298-0111
Phone No. 727-298-0955
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E-Mail: � �
Fill in fee simple Title Holder on next page if different
from the (Owner listed above)
,
Info@ComfortCover.org
E-Mail: �a 9
State or County License, OCCO57091
II If value of construction is $zsuu or more, a KMUKUCU JV0J1G i or I.Urnlncnl.cn�cn�
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SUPPLEMENTAL'iCON TRU'CTION: LIEN'-' a
FORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name: Dixon Enstneering.Inc.
MORTGAGE COMPANY: x Not Applicable
Name:
Address: 10410 Main St.
Address:
City: Thonotosassa State: FL
City: State:
Zip: Phone:
Zip: 33592i Phone: 727-524-1905
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name: !
Address:
City:
BONDING COMPANY: x Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to tote 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 Associationand 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 Co�es 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 fig�ancing, consult with lender or an attorney before
commencing work or recording your Notice of Comrinencement
of Owner/ Lessee/Agent
STATE OF FLOR DA
COUNTY OF F, c (645
The forgoi ing instrument was acknowledged before me
this 1-f day of Se - ' 20 / 6 by
4•�Jj1,L�
(Name of person acknowledging)
State of Florida )
s
Signature of Contract /License Ho d
STATE OF FLORIDA
COUNTY OF P,
The forgoing instrument was acknowledged before me
this I_ day of 20 1 b by
R�Ic�e�co. T, r l5&,rS
(Name of person acknowledging)
&&AuL � Q --0, -
(Signature of Notary lic- ate of Florida )
Personally, Known ��� OR Produced Identification i Personally Known_ OR Produced Identification
Type of Identification 4�roduced Rom'"' Type of Identification Produced
Public State of Florida, aYPr
pY PU N tary Commission No. 0 ublic ,,fate of Florida
Commission No. nn ade
r'F Og011fl y. R
niy Commiss q lyly Commiss 0601 t8
e> Ex ires 111041201,
v .� Notary Pu c e y � �
Revised 07/15 Anne Hillhouse
—wk. , Srete of Flotkla ,� My COm4 4 in 0n GG 139059
_., ., �nerVl91
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