HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- .4
All AP I ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: lqos-- C)UaLq
--- BY
St. Lucie County
RECEIVED
Planning and Development Services Building Permit Application MAY 2 C1019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential >"Uc'eCun"
PERMITTYPE:
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Address:
PropertyTaxlD#:
Lot No. 10
Site Plan Name: Block No. C?
Project Name:
Additional work to be performed under this permit -check all that apply:
,/Mechanical — Gas Tank — Gas Piping — Shutters Windows/Doors
, �/Electric VPIumbing
— Sprinklers — Generator V Roof Pitch
TotalSq. Ftof Construction: —Ccoc)
Cost of Construction:$ r�)TlXqc)o
Sq. Ft. of First Floor:
Utilities: �/ Sewer _ septic Building Height:
Name Adam Hotmol Naftest Fbrida� bit.
Name: Adaras Hoiries Of NOMMI F10rid0- William Bryq Ac
!!Y
Address: 4-C:0cw� Axtw-- 19"4.
,
Company: Adantsliornesd NoMwee, Florida.=
City:!�W-P OW4fW � _State: PL-
Zip Code: -7'�5 Fax:I%D-934f�520
Phone .6. 8� - cl-:24. C34-10
Address:-3� is-"Lp�y� PeLw.
City: G�� AWEW State1L
Zip Code: 5�9L5 Fax:'� *134. S5'33
Phone No f:6 0 -92V4. 04770
—
E-Mail: P6192-1-M;15 @-Tc!Qy7%3haweT. cow
Fill in fee simp�le Title Holder on next page (if different
from the Owner listed above)
E-Mail*etXyq- I
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State or County License.'CJW-t%lLl6 ��CrFR-
Wz z . .I.. ..% .. . 4�juuj or more, a nti.uKutu morice OT LOmmencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
�411
DESIGNER/ENGINttK: —No
Name:
tApplicable
.
MO RTGA GE COMPANY:
Name: Not Applicable
Address:
—
Address:
City:
Zip: _ Phone
State: —
City: �tate:
Zip: — Phone:
FEE SIMPLE TITLEHOLDER: —NotApplicable
Name:
BONDING COMPANY:
Name: —NotApplicable
Address:
Address:
City:
City:
Zip: _ Phone:
�;%A'R@
-
Zip: — Phone:
tril WIM I HACTOR 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 commended prior to the issuance of i permit.
StAucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in co 17ict with any applicable Home Owners Association rule�, 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 OWNEVE 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND To OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT--
1CFMF
Signature Or uwner/ Lessee/Contractor as Agent for Owner
STATE O,F FLORIDA',-- STATE OF FLORIDA—)
COUNTV OF(2�-M —Pvaa COUNTY OF (N�UTA 4(2 s,v
The fotgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this2adayof Mg!'�J 20j�j by thIS22i dayof 20_Lcl by
William Bryan Adams William Bryan Aclarns
. flumcew )
Name of person making statement. Name of person making statement.
Personally Known
Type of Identification
of
OR Produced Identification_
SHELLEYA. SEPULN
WOOMMISSION#GG
Personally Known OR Produced Identification
Type of Identification
of Notary
�HEMLUEYA116SEII UL
CO MIS
ISS I It
A my GG 2613 74
UtICI EXPIRES: Janumy, 251,�e 11
Commission No. q��N-2CILJ (Seal) Commission No.!$�2074 (Seal)
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