HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:— Permit Number:
RECEIVED
Building Permit Application MAY 17 . 2017
Planning and Development Services
Building and Code Regulation Division SCANNED
2300 Virginia Avenue, Fort Pierce FL 34982 BY
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial zlc_� Residential StlucieCounty
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
[PROPOSED IMPROVEMENT LOCATION: r. � - . I III
Address:
n%
Legal Description: 4,,-1 Z-4- 09 40,Fe,- f2 50 C, - A7 IV 6t5
03 0/, to a Cz
Property Tax ID #: 1�4 -5-f .2 - �7 0/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
P,0:,5r-t0,g-49 7-law
Ape- s 7 9 Z
CONSTRUCTION INFORMATION:
Additionalworktonenartormed under this permit - ChecK all apply:
0HVAC 0 Gas Tank E]Gas Piping Shutters Windows/Doors
Electric Plumbing OSprinklers Generator Roof Roof pitch
!!�E " MAO , 0 r=5 Sq. Ft. of First Floor:
Cost Of Construction: $ Utilities:F-]Sewer 0 Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name V1
Name: 9 0 63,F,4�7-
Address: J/,VcPc5 Vx2'__
Company: 077i;Z
City: -state:
Zip Code: - 2 !�p I? i6 2' Fax:
PhoneNo
Address:r0,0.
State: /—_4-
ZipCocle: 30(q 1�2- Fax:
PhoneNo.
Mavi 17- c0in
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License: C 33
IT vaiue Or construction Is �iZSUO or more, a RECORDED Notice of Commencement is required.
I-#
SUPPLEMENTA�,CQNSTRUCT,ION�CfENL,AW�INFO��og
DESIGNER/ENGINEER: Not Applicable
Name:,ejPreACZ Qq.-f-A1,9-5
MORTGAGE COMPANY:
Name:
Not Applicable
Address:.I.Zo w. al*-X-0 ~
Address:
City: .1-wir.6- wdpp-rw� State: r-e-
Zip:�W 4e--, Phone: �5r5r -5 9? 5 - �56,&;
—
City:
zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: --WotApplicable
Name:
BONDING COMPANY:
Name:
—Not Applicable
Address:
Address:
City:
City:
Zip: 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 ermit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners As7socfaflon rules, bylaws or anscovenants 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 property. A Nofice of Commencement must be recorded and posted on the jobsite
before the first in�pection. If you intend to obtain financing, consult with lender or an attorney before
as Agent for Owner SignatuFe of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO
COUNTY OF COUNTYOF AIee
The forgaing instrument was acknowledged before me
this _L.1day of In CLy 20 /-7—by
of person ackdowledging) /07 CA e P�.
C- i:&A"LL
(Signature of Notary Public -State of Florida )
Personally Known L�-/ OR Produced Identification
Type of Identification Produced
Commisslion No. F��Ocmo
Revised 07/15/2014
The forgoing instrument was acknowledged before me
thisL/Cdff6aycif e�W 20/2 by
pq D I&A 9.o Q--r : 5; 7 —A q K
(Name of person acknowledging)
Autq-t A
fSig'natureof NofaryPubVc-Sf6teof Florida)
Personally Known _OR Produced Identification
T Jpeof entification ProducediW,S,-3I;g2
31_19 ss n No.0 (4 (Seal)
961!
LOUISE BR7n7nwqk,
MY COMMISSION #GG073704
EXPIRES: FEB 15,2021
Banded thmugh let State Insurance
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