HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,ALL APPLICABLE INFO MUST BE COMPI ,,D FOR APPLICATION TO BE ACCEPTED
• Date: �� '"` Permit Number:
RFCC4 `40
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Building Permit Application
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Planning and Development Services 2101
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Building and Code Regulation Division D
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2300 Virginia Avenue, Fort Pierce FL 34982 Lu%
ant
Phone: (772) 462-1553 Fax- (772) 462-1578_ Commercial Residential
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PERMIT APPLICATION FOR: To Select from dro box, click arrow at the end of line T"o
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Address: L- gkS QAYc;rTR i 8. j F r• P 5=�3' fig! �6
Legal Description: 3'3 `3ti 1-lo S r^ �� za or ry L) i 4 iscss 4V ic�oFti L`I , V- OF
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Property Tax ID#: ILA31 - ado - e-joo3-00o -cj Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide: '
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Additional work tote narformed under tis permit - cneCK a apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
0- Electric I Plumbing []SprinklersEn Generator QRoof
Total Sq. Ft of Construction: 1 c4 0o SFt of First Floor:
Cost of Construction: $ 7 Soo Utilities: Sewer �5eptic Building Height: ld,
1On WE
Name �C4r\aV--,Clir`nA-IS�*AFL
Name: SbHr+ E_rvwrLcl t )
Address: L-loS o AvccrA-- w M-Y
Company: i0yJ�s =N c
City: - P icy -• State: FL—
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Address: C'i'a t5 W S*`* s
City: c3Cr;i--4- State:f=�
Zip Code: 3L-RLk(o Fax: ;v1A
Phone No. -1 7a - 3Sq - R\,c>'&
Zip Cade: 3 3o6`i Fax: Ss + 7`ba •o9gS
E-Mail: iJ\. A
Phone No. gOe� - D'-06 -66"> J
Fill in fee simple Title Holder on next page (if different
E-Mail: 1v\14r7yiP � A"r ANISO-R-A • �+
State or County License: c>"20' ?
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: x Not Applicable
Name: -ZAN``ss Name:
Address:_>'3Oo NEAddress:
City:_PaMpgNo State: P�f - City: State:
Zip: 3 3c*' -\ Phone: "154 _ c)fsG c x Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: _Y Not Applicable
Name: 13vzo rzacyc -rs _L.e- Plrv,Ec Name:
Address: /�So VF 1 V 601 Address:
City: N E w . Y gCL Ny City:
Zip: \00\9 Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the 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 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.
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 propeM
otce of Commencement must be recorded and posted on the jobsite
before the first inspection. Ifend to obtain financing, consult der or an attorney before
commencin work or recor ' Notice of Commencement.
rg rt_a ure=ofAa`ef, fJ::9gF��/:Lessee` S' are`o racto ji:icensea9olde�>�
STATE OF FLORIDA STATE OF FLORID
COUNTYOF S CLl wp(-cc-_-� COUNTYOF �rLovA'-tD
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this flday of 20jE�,by this cJ_day of-Zr 201A by
Z-6 lV F JY��J i2C-Ct��/ �Ol-k� �_ MylLrif�y
(Name of person acknowledging) (Name of person acknowledging)
C
(Signature of Notary Public -State of Florida) (Signature of Notary Public -State of Florida )
Personally Known ' 4— OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.F1= 19Sy` (Seal) Commission Nd.V-1-_ (Seal)
ALAN MILLERt•p:°�� AIAN MILLER
My COMMISSION# FF 195499 1 MY COMMISSION SFF195499
s, EXPIRES: May 5,2019 oe May 5, 019
Revised07/15/2014 �'Eacio"� Bonded Thru Budget Notary Samoa ho c Bonded Thru Budget Notary Senius
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