HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '&" -cd - ) -7 Permit Number: I I o U ` no (_4
co
Building Permit Application SCANNED
Planning and Development Services BY
Building and Code Regulation Division St. Mice C0'UnI
2300 Virginia Avenue, Fart 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
P,RYOPOSED IIVIPROUEM�NT LOCATION i' * �. t `" ,' '__
Address: -1"10 5 _ USIaU I 54- e )-i_ 3C�
Legal Description: f�� �C.y)?_il LP f; ,n � f� I "
Property Tax ID #: am4d oq - 13 If �hza - G (_ C ` �6 Lot No.'
Site Plan Name: V ion C.,S ' (?fl e, t� f Ga Block No.
Project Name: Vccz�(? ,s OY)k
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK
L y4 �. c1P. - r� n 3 rYSFt Ndi 4 rrri
STC.c'1-11�-- -'.,. ) : I.�G i per A)on,
S o �i) uJYtb; jar �1an rs �t I I L.�amS rCtdizr )
T'��n p:\r c + " CO" �v�o.I ram, e''I �5_is �rty'v &�nr
.s
J
OHVAC Gas Tank ❑Gas Piping _Sliutters Windows/Doors
Electric O Plum] i2qng Sprinklers Generator 1 Roof Roof pitch
Total Sq. Ft of Construction: OrX6Q-� �a�rL .Oifel, Sq. Ft. of First Floor: 7 , oO ('J
Cost of Construction: $ ) �t / CEO Utilities: 0 Sewer WSeptic Building Height:
OWNER/LESSEE m I_4
u h _
'
.GO
.CONTRACTOR
m. w•s.=
Namec G. i Q- ek ur
Name: �G.
AddresSS
City: P60 S }- L ur- e Stater
Zip Cod Sr2 Fax:
Phone No. `2
-``
Company: T G
Address:
City: -r e f (Q Stater
-1 Cl A� Zip Code: 24Fax:
Phone No. e!�'l--U l,2 i to - b03
--aoZ11 -- 1
E-Mail:: 11(CNl�HYGC\'hf `��K11S'a t •
Fill in fee simple Title rHolder on next page (if different
from the Owner listed above),
E-Mail: 0 c
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /�
Date: _q -LJ - J 77 Permit Number: 1-7 O/�/�j,,r�
Y- lJA
SCANNED
Building Permit Application St. LucBY v,
ie cni mf,se
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
0
PERMIT`APPLICATION FOR: To Select from dropbox, 9(ick arrow at the end of line 1� 7G-)
PROPOSE MPROVEMENT LOCATION: r
Address: % (o 1 f � LXI e t 5d
Legal Description: ) pQ> C' Y
Property Tax ID r#: - `t - U b O - C7 O - Lot No.
Site Plan Name: Y' -Q- Block No.
Project Name: S -
Setbacks Front Back: Ri ht Side: Left Side:
DETAILED DESCRIPTION OF WOR
L. —Il pqz p)&n
,+dd '51AL C-afl,neJ old P)Ufb;n plcyl
U51' n j 0A41 Sti (11 �Jel ectri c
reWVcW,R;) porn -for, CAP old p r lan
CONSTRUCTION INFORMATION:
MUU1 uUnG 1 wu,n w uc cnu, I,cu unuc, u,u y,c,uat—uic,, au aNpiy:
IIHVAC Gas Tank ❑Gas Piping _Shutters ®Windows/Doors
Electric ® Plumbing ❑Sprri7nklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 093. C.IrLc� Sq� F�t.I o first Floor.i [fib
Cost of Construction: $ Utilities: LJSewe Septic Building Height:
OWNER/LESSEE:
CONTRACTO
Name 21'1 fie, i F G-CS
Name: a
Address:
Company: o 1
City:'z)�- LUUt./ State: EL
Zip Code: 3y 9 'c; a Faz:
Phone No.(-1-)A') `n 9 `dr - S (o 3 g
Address: 1ZD0 T
City: State: -EL
Zip Code: 'Sc4cl og- Fax:
Phone NAr�-�n'��n) 01 to - �i�is
1
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: l CST Y �� Q (A (� CJ�tt
State or County :
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,SUPPLEMENTALGONSTRLICTION LIEN "LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:-
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
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.
m
the permit holder to build the subject structure
r and covenants that may restrict or prohibit such
!ed for any restrictions which may apply.
In copsideralion,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 afull 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
commencine work or recordine vour Notice of Commencement.
s
as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID_/- / STATE OF FLORIDg
COUNTY OF ` 4L LCC 1 &-1 COUNTY OF Jfi d- IA'IC� I -e-
The f r oing instrum,egt was cknowledged before me
this day of f� 20 _nby
e7�InA�` - C. (f�I I,� S
(Name of person acknowledging) '
(Sig Lure of Notary PState of Florida )
Personally Known OR Produced Identification
Type of IdentificatioRPFAdaed
U NDA C COLLINS
Commission No. , :': 'e my COMMISS( FF192590
?Terri.•` EXPIRES March 09. 2019
Revised 07/15/2014
The for oing instru ent was acknowledged' ,before me
this
T day of (7OV, _n
20 by
C . co ((IVIs
(Name of person acknowledging)
'(SikndtAre of Notary Public- State of Florida )
Personally Known] RFi 'C ltffic
Type of Identification (t¢ed LlnuA
i - My COMElsw�
N 0 FF192590
Commission No. ; r"ar.'.,••` EXPIRn1�9. 2019
p.1WO Cpl
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