HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �1 �Co 4 �5 Permit Number: � So 1 - a al 9
RECER' 'D SEP 161015
SCANNED
Building Permit Application BY
Planning and Development Services St. Lucie County
Building. and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15S3 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line � I kw�
PROPOSED IMPROVEMENT LOCATION:
Address: .f ZQi)
DLE-A9 �01 &Y1- Nl`/C
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Legal Description:,-3/ny
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Property Tax ID#:,3V63
-32.3-6002-6o0-2,
Lot No.
Site Plan Name: PD,;
Block No.
Project Name: 1-at6
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G'a9� dut's
Setbacks Front
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Back:
Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK: -.1 1
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CONSTRUCTION INFORMATION:
rtiona WorKtoDe-pertormed under tispermit-check all apply:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
❑Electric ❑Plumbing []Sprinklers ❑_Generator ❑_Roof
Total Sq. Ft of Construction: .51 SQ rr S Ft. of First Floor:
Cost of Construction: $ /� �fl Utilities: Sewer []Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name - SS/ A/L!1V
05
Name: ,� L, 7-
Address:/0-3 Gn/ Q1D /ln�
Company:;�0fiA- AV At10/;?6nm G(e-
City: T� >°itl2er
Zip Code:Qi. S Fax: 57-
Phone No. 7i7-
State: JE�_
Address: Pa lS.no /7xi�9
City: FH Pit-72lc_ State: rL
Zip Code: 3f%g763 Fax:
Phone No. 722—,5 - /Zd
E-Mail %/t YSrr✓ 60
Fill in fee sim le Title Holder on next page ( if different 1
from the Owner listed above) l A10J ' �9rv1,
E-Mail• J�l��� �iL,4 c✓a7Y�c /teTiffC . C'c�YI
State or County License: CG (, /,Sz7n63
If value of construction is $2500 or more, a RECORDEb Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: pIN F✓6AnlGlg ,
—Not Applicc ble
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 5; Z�� liA,2 io,J
T�42n25'i6 LJJ�
Address:
City: SA25fll
Zip::•ZO Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
/f P Pi -7,3,A-
_Signature of Owner/ Lessee/Agent
STATE OF
COUNTYOFORIDA S7 U(GL.E
The f r ing instru nt w s acknowledged Wore me
this 7qday of 20.pby
Notary D61blic-State of Florida
Person5gy Known OR Produced Identification V
Type.df Identification Produced 1 0((. LI CA&x"e4
Kenneth"d. GreerJg
Commission QTARV PUBV�+�eal)
STATE 1.
OF FLORIDA
Revised 07iMW14 Expires 1/1212019
P/PJ444 S
Si ure of Con actor/License Holder
STATE OF FLO IDA
COUNTY OF In1- Luau e,
The forgoing inst ment was acknowledged before me
this 1(0 dayof WPkt.-1y, 2019 by
(Name of person acknowledging j
07
Signature of Notary Public- to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
JACLYN DAWSONPRESSS�
Commission .N QTAR*PUBLIC (Seal)
j, L STATE OF FLORIDA
Expires 2(4/2017
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