HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED'
Building Permit Application M% 17 2017
Planning and Development Services CANNED
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982 St Lucie Countv
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
131161POSED IMPROVEMENt'_L6CATION'__-,"
Address:
Legal Description: 09 "e,- co C� 6-40 --V CZn e-V 1A.1
Property. -tax [D*.-* '1� - '7/-2 d:' 0d) 0 Lot No.
Site Plan Name: Block NO.
Project Name: -
Setbacks Fr'oili' Back: Right Side: LeftSide:
DETAILEDDESCRIPTION OF WORK:,-
HVAC 1:11GasTank E]Gas Piping U S'hu*t'ters F]Windows/Doors
Electric '_E:1 Plumbing [] Sprinklers ElGenerator DRoof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ .4
, � 6670
S, Ft of First Floor:
Utilities. Sewer E]Septic
Building Height:
OWNEk/LESSE_: JCONTRACTOR'
Name V1
Name:
Address:_J/,vcoc:D O'�9e--e .1-,u/ jO,,�
Company: 07;� we. r-&Itz 1Z -e-,v ^.1 /-1
city: 45Z",0,el -state: Ifil
Zip Code: 2 !;t? %5 ? Fax:
Phone No. 2 �7 -9- - 8 ly- a9eocv:k�
Address: A0 e,
City:4:V9J-,- A;_E�c C-A/ca� oz/F-er- State: 1��C-
Zip Code: 3 Vq %4 Fax:
PhoneNo. 22,z-
ftik""'gp'M �eOm
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: ' 5 rt'Z u e- 1-',' 67, C-40 rV
State or County License: C &-4- -"/&) 33
it value at construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAL CONSTRUCTION LIEN LAWINFOFMATIOW
DESIGNER/ENGINEER: Not Applicable
Name: gjPr-jgQ, Oct_g�fV,9_5
MORTGAGE COMPANY: Not Applicable
Name:
Address:/.ko rV. 4--r-0 //W
Address:
City: L. 5- We A TW State:
Zip:,"V-4,�p Phone:.TSr-.,!&S-�56��'
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: —fliot Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: _ Phone:
I certifV that no work or installation has commenced prior to the issuance of a permit.
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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 concurrencV 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 financing, consult with lender or an attorney before
commencihiz)wcrrk�ar ra'66rdine vour Notice of Commencement.
as
STATE OF FLORIDA STATE OF FLORIDA I
COUNTYOF 5k- Lt(c,1�6 I COUNTY OF I n cl- i -a� (?I y4�-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,12,dayof 41ay 20/7—by thIsJQ dayof JtAQ�j 20 L
by
dqA1 7 /7"� &� J ZV to 0 Q I Fle 09 70 :5; 7-Aq
:Name of person ackdowledging) /J76. et. (Name of person acknowledging I
&"_a, �_ ' L.. P,_4d_-nt A!2,2�pvc,4_A�
(Signatureof Notary Public- State of Florida) —1 (Signature of Notary Pu6lic-Stk4 &-t-lorilda )
PersonallyKnown 1,"� OR Produced Identification Personally Known — OR Produced Identification vll�
Type of Identification Produced Type of Identification Produced FLbL SH&,?
1 %^^^2 sionNo.006?30 Se
Commission No. fF6 961 J,7,, real)�owyfubft t. __L
a,, eal) NOWY Public State of F IOGW _al)
Rhonda c Bielefeldt
�p 0 . . __ — I LOUISF RR71)71
Revised 07/15/2014
EXPIRES: FEB 15,2021
Bonded through let State hurld
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