HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i &rmit Number:
SCANNE
BY
C TIE&VO Lopie County RECEIVED
Cie,
BUI'Aij'lliiil��ermit Application 205
JUL
Planning and Development Services
Suilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 V// Residential
Phone: (772) 462-1553 Fax: (772) 462-15781. Commercial
PERMIT APPLICATION FOR: To Seleq,� from dropbox, click arrow at the end of line
PROPOSED IMPRQVEMENT LOCATION:
Address:.
Legal Description: t5;:Qe
Property Tax ID #: Is - E;ok - bmos 660 -Lot No. —
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: I Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
oe
CONSTRUCTION INFORMATION:
AclartionalworKTOpenerrormed unaerthisipermit - cneCK all apply.
L
1JHV E]Gas Shutters E]Windows/Doors
Gas Tank Piping
-umbing rinklers OG
JaElectric lz�zl/pl enerator Roof
Total Sq. Ft of Construi;ction: 00\ S Ft of First Floor,
'CnSevverElseptic
a. 2 I Building Height:
Cost of Construction: $ I Utilities.
99:1,
OWNER/LESSEC'
CONTRACTOR:
Nam
Name:
CKCLC--\ %:7c'r\
Address:
Compan +
City: <_-�e State:
I E�
_�B
Addres
Zip co4e: Fax,
'A 10�9- ) I
City: W�� IPD_&CL�N -nq State*u
3-45T(O Q -) -
Phone No. (em!� Nci
Zip Code:
Phone No. ::z 7 49
- 1� q -
E-Mail; t,,,, �1,11 I a 6 c,,Q4N
Fill in fee simple Title Hoider'on next page different.
p
I ' 4 �t C e) r) (L;0'
state or county License: 4C a C__ 15q2 5
from the OwnAr listed above)
If value of construction Is $2500 or more, a RE1fb i RDED Q_otice of Commencement Is required.
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20% 000, )�'/Ov-
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
17 1
DESIGNER/ENGINUR: —NotApplicable
Name:
MORTGAGE COMPANY- Not Applicable
Name:
Addres
Address:
City: '2 51 �27t_C�
Phone:
State:
<'<n
city: State:
Zip: _ Phone:
FEESIMPFT[TkEHqLDER: _Noi:A�plicable
Name: (—Jr,\,a '611\1
L(_C
BONe ING COMPANY: —Not Applicable
Nam�
AdclresET
Addre ss:
City,
City:
!Zip: �56 J::) Phone: ' '
Zip: Phone: III
I certify that no work or installation has commenced prior to the issuance of a permit.
St.LucfeCoun makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in co 17ict with any applicable Home Owners Association rules, bylaws or an9coverants that may4estrict or prohibit such
structure. Please consult with your Home OwnersAssociation and review your deed for any restrictions w chmayapply.
In consideration of the granting of this requeste,
In accordance with the approved plans, the Flori
The following building permit applications are a,,
accessory structures, swimming pools, fences,,A
WARNING TO OWNER: Your failure to Re
improvements to your property. A Notic
before the 4psp inspectjpn. If you intend
'mit, I do hereby agree that I will, in all respects, perform the work
uilding Codes and St. Lucie County Amendments.
)t from undergoing a full concurrency review: room additions,
signs, screen rooms and accessory uses to another non-residential use
I a Notice of Commencement may result in your paying twice for
'Commencement must be recorded and posted on the jobsite
)btain financing, consult Aith lender or an attorney before
STATE OFTLOLRIDA- STATE OF A
COUNTY OF *�)� ICOUNTYOF
The ing instryinent was acknowledged befd I re me The forgoing instrument was acknowledged before me
this f7zod'ay,of (AA14-10— 20 /��by this _' 0 1.1;--by
da
JJC�yof
(Name of person acknowledging) (Name of person acknowledging)
1�_M - 6A ��'
(Signature of Notary Public- State of Florida)
Type of
Known ," OR Produced
BLANCA M. COBO
Notary Public - StaniSseallIorida
My Comm. Expires Apr 6, 2016
National Notary Assn.
Type of
Notary Public - State of Ro
Ay Corrim. Ex ires Feb 1 11
Commission # EE 140856
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