HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Dated Permit Number:WEIVED
•
Building Permit Application cc-f o`�.iala
Planning and Development Services Department
Permltting
Build}ng and Code Regulation Division St. Lucie Count
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 c�Ai�1�fFt1
'PROPOSED IMPROVEMENT LOCATION: ,... Sy
Addre s:
Legal Description:3-3- 3'\ `kd 14 — Ss, N 100 F� L-LIh C ofz r
21W c1-►E2�KEr ta�J� c�n��vQ�r� Sai�-wA�t� flrJn Lsc E �o�
Property Tax ID #: 11A33 - ao'3 -coo -mot Lot No.
Site Plan Name: Block No.
Project Name:
Setb icks Front Back: Right Side: Left Side:
'DETAkLED :DESCRIPTION OF WORK:
��S-ry�.L �•J . o a.� �qv b� czra u� A-� .� n►., � -� M bz o o F= a V �s�
16
,CON,1STR;UCTIOWIN`FORMATION:
Additional work to be ertormed under this permit - cnecK all apply:
CjHVAC M Gas Tank ❑Gas Piping _ Shutters Windows/Doors
❑_ Electric 0 Plumbing Sprinklers Generator Roof 3�•,� Roof pitch
Total Sq. Ft of Construction: age s� S . Ft. of First Floor:,'
Cost of Construction: $ Utilities: ] Sewer F-1 Septic Building Height: 16 tom'
OWNERAESSEE:. -
CONTRACTO.R:
Name
Address:
City:
SE F • S 1 SSpr,
Name: JOHN E MURRAY,
Company: AMS INC.
Address: 941 SW 8 STREET
C- 02
T ^, 1P1 e-5 -c71- State: E!_
Zip Code:
Phone
E-Mail:
Fill in
3 ��t"r.� Fax: r� \ A
No.
POMPANO BEACH Fl-
City: State:
Zip Code: 33069 Fax: 954-782-0995
Phone No. 800-226-6677
E=Mail: maryannp@amsofFla.com
n► � AL
fee simple Title Holder on next page (if different
from
the Owner listed above)
State or County License: CCC042787
If value of Construction -is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
I
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: JAMES BUSHOUSE
Name:'
Add ress:-,3300.NE,10TERRACE APT#24
Address:
II
City: POMPANO BEACH State: FL
City:
State: 11
Zip: Phone:
I
Zip: 33054Y ;, Phone 9e4-956-2203
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FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address: (oSa �s-41 -AVr, Fi t(o�1
Address: J
City: NEW -t N Y
City:
Zip: Phone:
Zip: k =,a \a Phone: lea . 44\
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.1L' cie County makes no representation that is granting a permit will authorize the ermit 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, 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 Amendments.
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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 i�pe Ion. If you intend to obtain financing, consult with lender or an attorney before
commencing workecording vour Notice of Commencement. ��
rSi- a Q " e L'_ " ntractor as Agent for Owner
r ig l _Gon actor%Lic� erase Holder
STATE OF FLORIDA
STATE OF Fl RIDA
COUNTY OF K3
OUNTY OF ewwmw
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of c�,r—rciog�r , 20A�; by
this � day of en , 20 CWby
-rD %A MU ZC-I-/4
JOHN E MURRAY
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known x OR Produced Identification
Type of Identification �paY PO
Produced �° : •'••� ALAN MILLER
Type of Identification
Produced ALAN MILLER
* * MY COMMISSION # FF 19549
* MY COMMISSION # FF 195499
EXPIRES: May 5, 2019
N�'9rFOF
f EXPIRES: May 5, 2019
N-""OF
F�OQ-SOP Bonded Thru Budget Notary Service!
F �Qo Bonded Thru Budget Notary Services
(Signature of,#%ary Public- State of Florida)
(Signature 9 tary Public- State of Florida )
ro ALAN MILLER
a° ; ••• ;,% ALAN MILLER
Commissi MY COMMISSION # FF 1954?%eat)
Commissi * MY COMMISSION # FF 195499 (Seal)
P(RES�&y 5,2019
OBonded Thru Budget Notary Services
*v*
ay 5,2019
Banded Thru Budget Notary Service!
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
-103A
Rev. 8/2/17