HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE/iNFO MUAT B MPLETED FOR APPLICATION TO BE ACCEPTED
Date: _5� (--41 Permit Number:
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Building Permit Application 1A.1
Planning and Development Services 2015
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 at. Public W
Luc,e .. orKs
Phone: (772) 462-1553 Fax: (772) 462-1578 commercial X_ Residential unty. F-L
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description:
4t ^lSfyN B4zk,_k, FL 3 1A s
Property Tax ID #: q511- 51q_.00o0_000_9 Lot No. I
Site Plan Name: Hu4c�; ti s " I s I c,-d C I V 6 Block No.
Project Name: -Fu-r Hv4t-�;K)u-, T-S Je_J C Ju L
Setbacks Front Back: — Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rtrnovld d-�_ -exi A`�,3 e,vtcJ uu,.l lo,-:!) rr to�,Av-,J W� o-P-, �t � otrV,_-)'4U evvir-
a,KCA ?0,rc� c�f-t_-,5 -, fJ-,LkJ4v -,� IV; ldf.V�31
CO RUCTION INFORMATION:
'Td�la�al WorKtotlenerformea unclerthis permit— check all apply:
11HVA1 F]Gas Tank E]Gas Piping Shutters E]Wjndows/Doors
-J-30 -
,Mlectric Plumbing OSprinklers Generator J_RRoof
Total Sq. Ft of Construction: �53,8 SC Ft of First Floor: 5 Mi 95
Cost of Construction:$ 1'_'J>k6?5S—o Utilities: n Sewer L Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Namel"Ix,%,w� Zla-d
Ali
Name:Ro-,r\a,\J —Kii1me,
17
AddressJ0410 -6 0(u.-,
Company: Cf,.
City: B,,� � , I-L State:
ZipCocle: 3 I/ci 57 'Fax:
Phone No.
Address: 7 �5
1� SY,
City: -� r 7L -State: FZ-
Zip Code: 3 11160 Fax: YI) 490 - 15-170
PhoneNo. -7�ol-960-064`9
E-Mail: P-tJ5+0,,MJ1'_7.(F_ c�LOI-tur-�
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: fov%�I�, Q K;r0'%" 4'\ cu�,Jr�v)"(Tbl (0 M,
State or County License: CGC_ QLM�_EY
IT value or construction is �iz5uu or more, a RECORDED Notice of Commencement is required.
A
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/ENlG
Name: 115MOt-�
[NEER: d.,
1. b
NotApplicable
J
ly� r+
MORTGAGE COMPANY: 4Not Applicable
Name: A
Address: 411-7 .5E: Cutoh-1 f'!)-
Address: 27
City: .5 If V �+-
Zip: 5q'I'16 Phone:
'r7j.- JL97!
City: — State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: Not Applicable
Name: P. /a
Address:
Address: 1111 ri
City:
City: f V//
Zip: Phonb:-
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Court makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conlylict with any applicable Home Owners Association rules, bylaws or an9covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and reviiew 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 joVte
before the first inspection. If you intend to obtain financing, consult with lender or an attorney befQr'e
0
— Signature of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDV
J�� n
COUNTY OF COUNTY OF
Thef r ing instrumpntwa4acknowledged before me ThefVrgoingins u ent was acknowleclg�eoeefore me
this 17day of V 20 L!5—by this4 day of 20 by
f p V ow "ing
(Name of person acknowledging Na ers �nowledging
of NoAy Puplic- State of Florida )
Personally Knov�—n V OR Produced Identification L.-rPerson�
Type of Identification Produced I Type of
Commission No.
(SEBORTNEY KIRCHMAN
Notary Public - State of Flo
State
OR Produced Identification
Notary Public - State at Florida
I "-;g' dnpv .... . .... - - _j;n#EE171771 J COMMIssion # FF 48061
Revised 07/15/2014 commiss 11 ...... BOrded Through NatiMal N(Xar
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