HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 0 T- L),-s
SCANNED
BY FuECF_1VZ-D
St Lucie County
Planning and Development Services Building Permit Application MAy I � 2017
Building and Code Regulation Division
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
�PROPOSED IMPROVEMENT LOCATION:
Address:
L-r r,�,- ry .5 ev Q)g�oe--M,
Legal Description: &flZ-4- Jq 40AF,,,' f2cp C, - IJ4:_�040 IV
Property Lot No.
Site Plan Name: Block No.
Project Name: ?
Setbacks Front Back: _ Right Side: Left Side:
I PETAILED DESCRIPTIONDF WORK-
e!�7 4v IV e-' 6;Z, jF-,5 r- 0 /9 *Y 77 0'RV
i< Al / 77-5- / ��/ / C 6- / F
ecl,'> 0'2-,o . e,
CONSTRUCTION INFORMATION?
Additionalworktobenertormed under this permit -check all apply:
LIHVAC Gas Tank DGas Piping InShutters Windows/Doors
11 Electric Plumbing []Sprinklers 11 Generator ORoof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:$
S Ft of First Floor:
Utilities Sewer E]Septic
Building Height:
I QWNER/LESSEE:
CONTRACTOR:
N a rn e 6,-'/ 4-Ct9— 0,F- 4- e i9D
Name: a'Or3a'r 'Ir 7_491 go- f&__
Address: J/,vcpc�, 0/2—,
Company: 07�4`;Z
City: &240-,-f 1,4'- state:
Zip Code: 2 5t q !6 ? Fax:
Phone No.
Address: P9 4::V,
State:
Zip Code: :3 9c? I'/- Fax:
Phone No. 2 2,:' 2 - .9-15
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License -
it value at construction Is 525UU or more, a RECORDED Notice of Commencement is required.
PLEMENTALCONS Ucrm LIEN LAWJNFbkmAT.iqN--
WE-JJUn1rK/r1%1121n1t:t:K: — NOTAPplica e MORTGAGE COMPANY: Not Applicable
Name: gjoiP-Aa 0"�64%/ Name:
Address:/.to w. J--r-0 Mw Address:
City: /- Wl-:;� rt, W go A TW State: City: State:
Zip:,�53y-e.e--, Phone:.!r5r-.c5g?:5-_56,?,6 Zip: Phone:
FEE SIMPLE TITLEHOLDER: -!f%ot Applicable BONDING COMPANY: —NotApplicable
Name: Name:
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 ermlt will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners AssocFa tion 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 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
K S
Signature of Contractor/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF S+, Lucie COUNTY OF. Xf-�'M
The f Ing instrumeot was acknowledged before me
this May of M j;6q 20 LI;Lby
�M# r-ZC; 07 du— FJC�- —4� i
g
person ack Rbwl�d Ing) 1,7C— e4_-.
&&,L, C. &d, 4 g,) 4 —
'(Signature of Notary Public- State dif Florida)
Personally Known L,-' OR Produced Identification
Type of Identification Produced
Commission No. FF Og 6,
W ?4 Notary PUbI10 StM
Rhonda C131elefiald
Revised 07/15/2014
The forgoing instrument was acknowledged before me
thls&L'tayof 20/_�
.� by
04 0 :;5; 7-Aq K
(Name of person acknowledging)
(Signature of Notary Public- Stafe bf Florida
Personally Known OR Produced Identification
Typ e of I d entill card o n P rod u ce d Pl< 4.qr, > -7 & &.-r T- 35-W-2
No4tq 10 92) 40 (Sea[)
MY COMMISSION #GG073704
EXPIRES: FEB 15,2021
Banded thmnah let State IftsuranCe
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