HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIIC-rABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / d
Date: -�7� J Permit Number:
RECEIt.'^D JUL 2 71015 SCANNEL.
• _ _ BY
Building Permit Application St. Lucie Coiwt,
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line D9. ek
PROPOSED IMP.-,ROVEMENT LO.CATIQN:
Address: 1�5_00 GASoh Pales Cl�'
Legal Description: 16r6ov.r RiaGe PI —AT Z - OAXTtNAlJCe iWA (3.9VAC
Property Tax ID ��Z���d����32-1)�� 2 Lot No.
Site Plan Name: Block No.
Project Name: P d
Setbacks Front Back: Right Side: Left Side:
DETAILED. DESCRIPTION OF WORK:
Ch-inge oi4 Vron�- JeclL oiia kh^'P 4ri &eei- A-OA
CONSTRU,CTIO,N JNF.ORMATIQN:
❑HVAC ❑ Gas Tank
❑Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ � 5�u
Piping ❑_Shutters ❑Windows/Doors
nklers ❑ Generator ❑ Roof
S Ft. of First Floor:
Utilities :Sewer ❑Septic Building Height:
OWNER/LESSEE:
.CONTRACTOR,:
Name i-Webow PUS 5P, POA
Name: PAUL SAMPSON
Address: 1o2(.w NW 11•A%' 9Ngf, 90
:Company: TLC EXPERTS
City: P= State: F1
Zip Code: 7 Iq'i D Fax:
Phone No. i-72 - � _i(o ' 3 CDC) 0
Address: 1237 DELAWARE AVE.
City: FT. PIERCE State: FL
Zip Code: 34950 Fax: 772-466-1655
Phone No. 772-466-7626
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: keith@ticexperts.com
State or County License: CBC1258197
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFOR'MATIO'N;
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.
St. Lucie County 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: 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
Lessee/Agent
STATE OF FLO�p{p TI
STATE OF FL II ,11
COUNTY OF �1 L�l t COUNTY OF
Thef r �0ginstr men a acknowledged fore me
this day of 20 by.
of person
State
Personally Known #— OR Produced'IdGrll`V
Type of Identification Produced _ 4t
Commission N0. 3 : ,.V4al) 4EE197M
Revised 07/15/2014
The for�,,oinstr men was acknowledged before me
this �lJday of 20 AS- by
n
Personally Known)OR Produced
Type of Identification Produced
Commission No. ct(J (S2ala:. pEE 197836
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