HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,� �T
Date: -- Permit Number: ) W''U61? % (4
RECEIVED
Building Permit Application U#3015
Planning and Development Services St.BY
CouBY
Building and Code Regulation Division nty
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: .'I lit VtS f ll_ - I wllt ?_zA;'1 Jsa;r %-I L-UC,IC:
Legal Description:y%51-%Y Sr E11C_Ior- Zt",. divOF- 2oI Zna253f.-(pq
v
Property Tax ID#: 91'fPl-560 --bt{2!8 -<U::PD
Site Plan Name: 0�e(
Project Name: 05WOU
Setbacks Front Back: � Right Side:/_ Left Side:/(/
DETAILED DESCRIPTION OF WORK: = -
Lot No.
Block No.
AaanionaiworKtoDe errormea unaerimsperma-cnecKau appry:
❑HVAC 1-1 _Gas Tank ❑Gas Piping _Shutters 12�windows/Doors
❑ Electric ElPlumbing []Sprinklers❑ Generator ❑ Roof
Total Sq. Ft of Construction: 10C; Sc —F�t. of First Floor:
Cost of Construction:$ 4AO,00 Utilities. nSewer ❑Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addres . - ✓f I 1
Company: r
City: o✓(= S%- [ tic l State: V L
Zip Code: Ru6.c!�2_ Fax:
Phone No. 55 1 - Y ?2-G(S5 r
Address: /V
City: SHU eln_ - fZ_ Stater_
Zip Code: 2 H r7'4G Fax: (o I?- - 5] 7 4�/
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 4f fc--aimu
State or County License: Cac I rp 8 Ll ?
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 TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict 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, Yoty fail to Record a Notice of Commencement may result in y r p Ing twice for
improvements to your pr ert A Notice of Commencement must be recorded d os on the jobsite
before firs speCti . If intlzfid to obtain financing, consul h Ig�d or n rney before
com encl ork r cor o r Notice of Commencement //
w �. i l s
_ Signature of Owner/ Lessee/ gent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .ST 40C/E COUNTY OF ST
The for&�Qqing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this/��day of� 20/ by this!_S ay of Z& V , 20/_� by
(Name of person acknowledging) (Name of person acknowledging )
(Sign ure of Notary Public -State of Florida) (Signs f Notary blic- State of Florida )
Personally Known ✓ OR Produced Identification
Personally Known V OR Produced Identification_
Type of Identification
Type of Identification Produced
'f"'••
�=
ANNK GAUMOND
rif••,«
AVMOND
Commission No. .«
NIY COIB>NIjN1FF 1739D7
Commission No.
iFF17a9U7
a•.
EXPIRES: December 7,2018
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EXPIRES: Decomber7^2012
.s'f.-ur L'
Bonded TAru Wn PuU'n Unde�n
;
Revised 07/15/2014
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