HomeMy WebLinkAboutBUILDING PERMIT APPLICATION--------------
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATrON TO BE ACCEPTED
Date: I l2� 1'J Permit Number: s 11 ' 0 'a
RECEIVED NOV 161015 SCANNED
Building Permit Application St. Luce County
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 IineWq\\ 4 h III
PROPOSED IMPROVEMENT LOCATION: nL
Legal Description: G��VAh h r 0L ?A i/1 — L t\ 441r
PropertyTaxlD#: (41�f '�!'`�bi"1 QQd-1 Lot No.
Site Plan Name: I VOIA&j i--Abn C (, �/ (/eli Block No.
Project Name: tA/'% 6 1 n 6 r. Fvi� rf c c, �r o A 5
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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ag
INFORMATION:
HVAC "Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ JT ci 6
Piping
Shutters ❑ Windows/Doors
Generator D Roof
S Ft. of First Floor:
Utilities: �Sewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name _okIlrny ithfyUn
Address: �ItT � �t '�3 ��1
Name: ,M /I/ S G !✓
Company:./
City ( r -e State: M
Zip Code: 3I aK 6 Fax:
Phone No.772, ,4G7-0(1
Address: Z� A/ Hr4/_,- q 1W 1zlq
City: 17., G� State: r�4- pp
Zip Code: 32r70)_ Fax: go,77_q�--(eD'd
Phone No.4fl7-20�13 3
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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E-Mail: /�G�F' CG /lYl Cl Pnn{7II� t �(�%SS /hC
State or County License: FS 1 Zap Y(nY V
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Nam° plicable
/
MORTGAGE C MP Y•
Name:
_ Not Applicable
Address:
Address:
City:
Zip: one,
State:
City:
Zip: Ph e:
State:
FEE SIMPLE TITLE H LDER:
Name:
o plicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Addre
City:
City 74
Zip: on
: Zi Pho
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 applicatiohs 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
commencing work or recording our Notice of Commencement.
s
_ Signature of Owner/ lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTYOF nrri ricC
The forgo.ng instru ent was acknowledged before me
this I'''r7ay of 4?r 20 j5 by
Ocb-)ACL C&
(Name of person acknowledging )
/I IL -al 4. Cfc
(Signatur of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificat' n Produced
c°`; •• �o WANDA S. CIARY
Commission No. I FI(pgJr 2 # ($eWIIICOMMISSIONtFF168%
.. EXPIRES: October25,2018
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF (Dr� r1 c
The forg,a1'yng inst u ent was acknowledged before me
this -LL%Y of NOUP K�_6 t , 20 J�;_ by
(Name of person acknowledging)
(Signature df Notary Public -State of FI rida )
Personally Known OR Producg�l Identification
Type of Identifica on Produced a°"" °�� WMDAS.CLARY
MY Gomm r
Commission No. FF I(Q'a5 yZ iS( On, ES:October 25, e2018
nim
�2cr m dThru Budget NotazyServkee
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