HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6/22/2016 SCANNED Permit Number: /�O 7 O �J 7
St. Lucie Count,
RECEH/E
Building Permit Application JUL -8 2016
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Building.
PROPOSED IMPROVEMENT LOCATION:
Address: Rangeline Road Sec 33 Town 37S Range 38E Port St Lucie FI
Legal Description: 33 37 38 E 1295.39 FT OF SEC -LESS C-23 CANAL RIW-(147.30A)(OR 3639-2060) RtL
3499 1
Property Tax ID #: ��
Site Plan Name:
Project Name: City West
Setbacks Front
i-1) li- 0001 -000-
N1119�
Back: Right Side:
Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:. III
Installation of new 30OFT Guyed Wire Tower Site
CONRUCTION INFORMATION:
�ddrtSTiona wor to rienertormea under this Dermtt— check all that aoo v:
HVAC Lr I Gas Tank UGas Piping
Electric 0 Plumbing Sprinklers
Shutters ❑ Windows/Doors
Generator 1:1 Roof
Total Sq. Ft of Construction: 10 S Ft. of First Floor:
Cost of Construction:$ z� � Z�f 'PJUtilities:SewerDSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LU (
Name: Thomas J. Carrick
n 0
Address: 11-1 �J' bjUt
Company: Carrick Contracting Corporation
City: fmA &A LU 1 State: � I'
Zip Code: 34Fax:
Phone No.
Address: 1450Xinetic Road
City: Lake Park State: FL
Zip Code: 33403 . Fax: 561-844-5641
Phone No. 561-844-5322
E-Mail:
Fill in fee simple Title Holder on next page (if different
f the Owner listed above) C
G r
E-Mail: kcarrick@carrickcontracting.com
State or County License: CGCO55115
yr vaiue or construction is S2500 or more, a RECORDED Notice of Commencement is required.
1-7�`1��.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: x Not Applicable
Name:
Addre;s:�
"-J Id ' U I b
Address:
City: (��( State: _ _
Zip: 6�1�A Phone: M u _ QA
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: x Not Applicable
Name:
Address:
City:
BONDING COMPANY: x Not Applicable
Name:
Address:
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 Aon 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. t 11
,
/ A
s
_ Signature of Owner/ Lessee/Agent
Signature of Contractor icen a Hol er
STATE OF FLORIDA
STATE OF FLO q
COUNTY OF
COUNTY OF IYYIG(C�l
The for oing instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this3o day of20ljby
this&W day 20by
rt, raAL Sc_-i�6&,e,
-'�_ V\[]YXCi �' 1- 0QrrtC�_
(Name of person" acknowledging )
(Name of person acknowledging )
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(Sig re of Notary Public- State of Flo da
kNgn Lure of nryPublic- State of Florida )
Personal) Known ,...... r i on
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Type of Identificatio-Commissioril
Perso`Y II K '
Type of Iden icab' ucedJACLYNN E. MCNEVIN
t a Expires December4, 2016
re° ¢a4_ Notary Public - State of Florida
Commission No. ftWn Tr,se9Yj.80W(15-7019
Commission e: WE Commission/(BrOP222
My Comm. Expires Jul 30, 2020
Ilmdadthm,gh Natbnal Notar Assn.
Revised 07/15/2014
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