HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �9
Date: SCANNED o %C Permit Number:
BY
St. Lucie Countv
• Building Permit Application RECEIVED
Planning and Development Services AUG 10 2015
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
.PROPOSED'IMPROVEMENT LOCATION:,
Address: i E, D i Wcs4- m uI F+ Pierce 3 z}9?1
Legal Description: L hoe r . �-
Property Tax ID #: , 340 3 - J02 - b 1) 1- 0 0 L)-- X Lot No.
Site Plan Name: 'F E P 1 i Block No.
Project Name: U lie ! NIL i} aM i Yl
Setbacks Front ack: Right Side: Left Side:
DETAILED'DESCRIPTION OF WORK
I'CONSTRLICTION'INFORMATIONa
I_JHVAC L__jGasTank UGas
Electric 0 Plumbing ❑Spr
Total Sq. Ft of Construction:
Cost of Construction: $ � �I LPun
Piping LJ Shutters
ers Lj Generator
S Ft. of First Floor:
Utilities: 0 Sewer D Septic
Windows/Doors
0 Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:,
Name L)CI(' OLM
Name: bono-a((J2S r
Address:a.3W /'i('c. -rLiG
l(P•
Company: DW J e&'f t&nklYfCPS+-Tf -C.
City: Eb(i- 8ei-c' e State: D_
Zip Code: .� k� Fax:
i
Phone No. 972. - !11 L•
Address: � SbQ W 79f"/41/f , -W -;LS__9
City: f�"a o_0 State:
Zip Code: _ j 31 2 - Fax: 5? �- ` J3-017S
Phone No. _Si.P I - 8) ff - L/D9
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:. LI as+ a dh&L ccerc {iuT n , uyy)
State or County License: ck. )2 LI73 0
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is"required.
I.SUPPLEMENTAL'CONSTRUCTION-LIEN'LAW'I,N FORMATION:;
Name: ('I1�iS�fliF�11�c� (Cu)S, PC
Address: 13Lo' e .
City: jQf) State: (nZ
Zip: 9 ,-Jq Phone:
FEE SIMPLE TITLE HOLDER: �t Applicable
Name:
Address: mi a
City: '
Zip: Phone:
MORTGAGE COMPANY:
Name:
IfNot Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
L-Not Applicable
afft
Address:
City:
Zip: Phone:
1 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 1 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
commencine work or recordine vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIRAG e
COUNTY OF _
The forgoing instrument w s acknowledged b fore me
this 1�day of �)I n � J 20I by
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
�•�
,+iih%"•, MAN BELLAMY C
ommission # FF 194056
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF P—Jm BeJrah
The forgoing instrument was acknowledged before me
this -a-day of _TJ 111 20 IS by
(Name of of person acknowledging)
(Signature of Notary Public) State of Florida )
Personally Known VX OR Produced Identification
Type of Identification Produced
KA ING
No. E,Rj'PUBLI
STATE OF FLORIDA
Expires 9/2212017
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