HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- 1
ALL APPLICABLE INFO MUST BE comvL l,ED FOR APPLICATION TO BE ACCEPTED
Date: Q L C ) SCANNED Permit Number:
BY
St. Lucie Count,
z 103 l LTW
Building Permit Application DEC 2 3 2015
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 t/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION:
Address: G G S't v s A —
Legal Description: _S V= 0- P C Oc t+Lrn
Property Tax ID #: 3y 1 S - .SO I - 6 0 6 S - 00 o - y Lot No.
Site Plan Name:
Project Name: L , /G L !L ;�D -r/d- K
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: III
Sr 7-/4L__c- 2K 6 v L �- G fI-T>= e AOX S IS+'1 vn
ex ks r C'-J
L �-'_ 0-C_4-f i L
CONSTRUCTION INFORMATION`. III
11HVAC U Gas Tank
11 Electric El Plumbing
Total Sq. Ft of Construction: 12 0�
Cost of Construction: $ 4 g U o
Piping
0 Generator
S Ft. of First Floor: _
utilities..El
11 Windows/Doors
U Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: :ED_r 4-0 - V0 M 13(4Giz
Company: 5 r Sn co i ✓l Q�nU--I
Address: 66 S `f U S
City: ST State:_
Zip Code: '3 `GAS Z Fax:
Phone No. 51 Z' i 05
Address: Ib �. a �7 S e ZLv%vnc-c/ 2 .1
City: 1702 c- S T L vG,'e State: f_Z
Zip Code: 'S 4 ciS Z Fax: -S� -.7 -U T'0 6
Phone No. 77Z - -5 3 S- 2 Y`L /-
E-Mail: (A 4c11, Gn 5 U ,"i'( err 0 /yla . vl&i l
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: S i C Af ci C can ¢ c r,' o-i P s e-¢ c r ' o� 5 e
State or County License:
&-S /2,3 ov 3 6U
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: PwN w 2 ch C; L
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: tk cG`-t aI Lv-^�Pr-c.- s rr
Address:
City: (b r v SX t u. W z State: L
Zip: 3't R`6 Phone: 75'5-4G6
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: S'tac-c._ ! n11 Ltd
BONDING COMPANY: _Not Applicable
Name:
Address: Po6o� i7- o9 3sl
Address:
City: r-L
City:
Zip: -5 -z,,o 1-7 Phone: 99�) - tr-7/ - Sp S' c4,/
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counter 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
commencing work or recording vour Notice of Commencement.
/ez�Lz:
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The or oing instru�gnt was acknowledggd�e€ore me
thi day of \) 20 Irby
(Name of person acknowledging)
(Signature of o ary Public- State of Florida )
Personally Kn¢ I at'on .
Type of Identi uced i
s
Signatrue of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S-F L_uc i (fi_
The forgoing instrument was acknowledged before me
this 11 day of D P_-C.. 20 I;> by
-Edward L�1�ei�a ce
(Name of person acknowledging) /
(S' nature of Notary Public- State of Florida )
Personally Known v1 OR Produced Identification
Type of Identification Produced
�. r � numary public •State 01 Florida
Commission COmmIs8 OR i(g��4730 Commission No.
p� itopa• m. Expires May 27.2019 IF
(Seal)
I" Iff ':1 My COMMISSION OFF00922211
Revised 07/15/2014 �vZaF'* /'r EXPIRES August 7. 2017
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