HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:—? - -2 -20/5' SCANNED Permit Number: IS�� 0091?
BY RECEIVED
St. Lucie Counr,
low Building Permit Application . MAR -6 205
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 A Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line , I
PROPOSED IMPROVEMENT LOCATION:
Address: 5"'76 d
Legal Description: a7 A- 3 9 Tti a1 P�v to-, 74�9'f 4- 4')r14 lVi4d 9-p : Cy N. w 4-
64 .w617 2 Aoi,_
PropertyTax ID #: 33Z7 - 3/t%- O'oZ/ _ 0oo - 0 Lot No.
Site Plan Name:
Project Name: 41e/%r4W/14-nc 1064 -R-`es ^" /
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK:
z/6%, SA
rE psi �y
✓/o ., MG.-�� .e c' �L9 . � -'ttw A, C%''-, � As l! i fo
%u ��[bs / ..G•�s-fca �SLi..le s� z.,64^5e. �&••�,ne/ .k /.7,r'
V A9 , a 23
CONSTRUCTION INFORMATION-
- cnecK a
HVAC "Gas Tank IJGas Piping
LJElectric ,OPlumbing uSprinklers
Total Sq. Ft of Construction: A%1 5'8'
Cost of Construction: $ 7i S-z r
Shutters Windows/Doors
Generator R Roof
S Ft. of First Floor: _
Utilities;llSewer OSeptic
Building Height: /f
OWNER/LESSEE:
CONTRACTOR:
Name Sex✓E O9-L y
Name: o2il.4 nf� Z
Address: OVS9-
Company: g G1 LGn wcy rJFC
City: ✓cVIAr a State:Fc-
Zip Code: 334S-S, Fax: 567- 294 - 6L0/
Phone No. /6 /-2/ J6 - G ZOO
Address: /SS/ 4 (�rzor�Rc 9�
City: .ift.l m//- State:_
Zip Code: 3(15W Fax: 772 7s'2. c(r7 Z
Phone No. 77 Z Z 3Z !;-'S/ ZZ
E-Mail:_ /?AcA d7 gi-ArA I-,eW 4M& . ce^—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: av%?rna..Pp`¢i�
State or County License: CC( -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
XNot Applicable
BONDING COMPANY:
Name:
_4Not 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 permit will authorize the permit holder to build the subject structure
which is in contlict with any applicable Home Owners Association 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 o�3n attorney before
commencing work or recording vour Notice of Commencement. ( J i
Lessee
STATE OF FLORIDA
COUNTY OF 14.6cT1.,1
The forgoing instrument was acknowledged before me
this 24 day of V'1127 $4AL4 20 16 by
C-4 bgkk l eS e;--S
(Name of person acknowledging)
S.
of
Personally Known / OR Produced Identification _
Type of Identificatio
w� Notary Puppils State of Florida
Commission No. l'.AN ito.�of1.(689Ni.
Expires 11/18/2015
Revised 07/15/2014
Holder
STATE OF FLORIDA
COUNTY OF %&ho ( 1l
The forgoing instrument was acknowledged before me
this g;"bayofSNSUK�.4 .20_1 by
� mo4tL
(Name ol person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known ./ OR Produced Identification
Type of Identification
.Y`•� Notary PuqIJs St mot Florida
Commission No. +4 Kenneth L�T�
�� A• My Commission FE121732
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