HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLE*D FOR APPLICATION TO BE ACCEPTED ^ I' C[��
Permit Number: f5710,-D&4-7
Date: SCANNED
BY
s _` St. Lucie Countv
Building Permit Application
Planning and Development Services
Building and Code Regulation Division q"
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 II
PROPOSED IMPROVEMENT LOCATION:
Address: 3 S64 5+. Luci2 Alum( ) F+- P> ,P_✓cA tF— 3,4g14 n
I Description: dq 34 4o ay 5cu Cat 0
/ "TO W Ll oF54E'C, _r4 597- SI 34 E
Fr
LT -
Lot No.
Site Plan Name:
/� Block No.
Project Name: Chips CgS}6m 00l1nVY\I
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
iYlSio�0.�im 0� %bvN-V\ Gro moth
CONSTRUCTION INFORMATION:
rtiona wor to e e orme under
ETW Gas Tank
tispermit—check
❑Gas Piping
all apply:
❑Windows/Doors
_Shutters
Electric 0 Plumbing
Sprinklers
Generator
Roof
Total Sq. Ft of Construction:
\Construction:
S Ft. of First Floor:
0Septic
Cost o $ k"', bCS.Ou
Utilities:InSewer
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name C
Name: _-J70J, V, rl&4 k gue`0
Address: 2300 U Lq lnt`a
Company: JF&, C C6 )5'F: �t U-(\ 07eS Co,'P.
City: F'f PI.2✓ f P State:
Zip Code: 319R� Fax:
Phone No.
Address: (o f 7 S w ah � 0 *100 IS
City: )i' eaA State:—fl—L
Zip Code: 3 30 17— Fax:
Phone No. I-/S Scl
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: V_bu2✓t O 63 eP_ yQ/t00. Con-x
State or County License: C6-C 161 L13 (a a
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: > Not Applicable
Name: TE.I r,nv� pEa(�119 Name:
Address: _a.:) 13 LaHr.L Address:
City: PQ I u. Ka G7CG r%vr aro s State: City: State:
Zip: 33 418 Phone: /--S6 l aS_ 6Lf-5 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Y- Not Applicable
Name: _
Address:
City:
BONDING COMPANY:
Name:
Address:
Zip: Phone: I Zip:
Phone:
_Not Applicable
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
commencing work or recording your Notice of Commencement. --,
U'- /a(L-
ysS gnature oWwrier Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF Palm Beach COUNTYOF \)Cn yrnry_�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 'b day of 1�C_ 20 Eby this day of �3 20 -IS- by
ChaN1-el . Cpr\s1 rDv►� I JOhnr
(Name of person acknowledging) (Name of perso ac nowledging )
(Signature of Obtary Public- State of Florida) (Signature 6
Notary Public- State of Florida )
Personally Know o uc�dul&tific
Type of Ide rc7Si nproduce(MEGHAN m Rudd
r •_ .4u..�,.. Notary Pu5TiwB5 p 10,2
Commission N • @ Comm• nn Owl
Revised 07/15/2014
Personally Known V OR Produced Identification
Type of Identification Produced
fJp_ MEGHAN H. CAM (Seal)
Notary Pu is - State 01
Florida
My Comm. Expires Sep 10, 2016
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