HomeMy WebLinkAboutBUILDING PERMIT APPLICATION4, . "')
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % �� SCANNED Permit Number: /M • 0 �o�T
BY
St Lucie County
Building Permit Application �-� 9%
Planning and Development Services
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 III
I PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description: RC86/ t M AAI .4D 731-X e 16 7-1 4N 0 A .PT A,ut A} .5 I51 OX ,Lo`i�2
FlAJO GT SYRrp .l-yG ld Of hNri Ab3 %o [o71 A A21) At t I.GSF�O� �fla�
Property Tax ID#:<9y,V 3 YDS-O m5 pooh Lot No. / 2
Site Plan Name: / n_ Block No. FA
Project Name: 2C k 541�
Setbacks Front 9? � Back: Right Side: %B � Left Side:
I DETAILED DESCRIPTION OF WORK: III
- evzPi Q % _ g ,I
CONSTRUCTION INFORM TION:
iArifitnnalworKtotienerformed un er t is permd - c ec a apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
❑Electric ❑Plumbing 05prinklers ❑Generator ❑Roof
Total Sq. Ft of Construction: g� S Ft. of First Floor:
Cost of Construction: $ /y ooa O Utilities.
I] Sewer❑Septic
Building Height: 4 �pi
OWNER/LESSEE:
CONTRACTOR:
Name 9Q'z&LA'd (/,.�ir�
Name:
Address: i a S� 7 u � �
Company
n
City: '2f. State:
Zip Code � Fax:
Phone No. 2E f62 " may 3r��A)
Address-331 I '
City: ,�J nn 11
- /� cue
Zip Code's y 1. Fax:
Phone No. 77a - 116 J/-D -j
State:,
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: -5I6 NS -I (Soa7y ,
A}j%
State or County License: 6 % o 04 D /.5-7
'gi-ic 4 3 6
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE ( GINE •
Name:
Not Applicable
M_
MORTGAGE COMPANY: _ Not Applicable
Name:
Address.
Address:
City:
Zip:311a11 Phone:
State:
-??I-<- 4
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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.
no
: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 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
commencing work or recording vour Notice of Commencement.
Signatu of owner/ ent Lessee
STATE OF FLORIDA J
COUNTY OF _I )F AA-6;
The for ing instru ent was acknowledged before me
this day of 64n, 20by
Trade L Lamb
Commission No. h C x MV commissicfti
Revised 07/15/2014
Signature of r
ntractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrum nt was acknowledged before me
this`. ay of 20diby
(Name
ofofNota�ry ublic-State
OR Produced Identification
.y+W Notary Public Stale of Florida
Commission No. Trade L (Spo1l
My commission h 159114
%CM1.1 Explres0l/2512016
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