HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APP [CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: SUANNtIBermit Number: I(ODS" p+�
� Q'
` BY
o St. Lucie County ECEIVE
Building Permit Application
Planning and Development Services AUG 12 2916
Building nd code Regulation Division PERMITTING
2300Vir liniaAvenue, Fort Pierce FL34982 St. Lucie County, FL
Phone: 772) 462-1553 Fax: (772) 462-1578 Commercial � Residential
PERM[ APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPQ ED IMPROVEIVfENT.LOCATION
s s;
Address: 0 j D W i%w 42,0 6i-D
Legal Description:
Property 'axlD#: 3y03-S02-0050 -U50-% Lot No.
Site Plan I lame:_
Project N me: P% DrJDA-Y Ji EcJ-A-LK Block No.
Setbacks Front Back: Right Side: Left Side:
vuziw u UtJIKIYI IUIV:UF'-WURK '-� .� ::� � -
�� Side Con neCfi'"Li
wIvSTIUCTION INFORMATION..
L.J Gas Tank uGas Piping
I ic 0 Plumbing Sprinklers
Total Sq. of Construction -
Cost of Co struction: $ �, p OO , dd—
Shutters ❑ Windows/Doors
Generator ❑ Roof
S Ft. of First Floor: _
Utilities:,n Sewer 0 Septic
Building Height:
OWNS
Name`
Address:
City:
Zip Code:
Phone No
E-Mail:
Fill in fee
from the Owner
If v his of
LESSEE:
) O1,W J (kCo(3S
:CONTRACTOR
Name Tol{IJ �j (}Cc)BS
70 D(-G7i-HIDE-e'C /{ilCn�uE
Company: To AW 'TO C065 (oAJ s 7ttuc-n o� T JC-
State: FL
3'/96z Fax: '%24&6—(AY4/
_ 772 5 /g-0 i?1
Address: _ `70 1 0 LL-)IWP M /}-Vc,UL..c
City:_ FT—AIC� State: FL
Zip Code: 3cf 9� 2- Fax: 772
Phone No. 772 5-/9-07911
jacobs47ol mail.eam
imple Title Holder on next page ([f different
listed above)
E-Mail: _ J (K A Cc&S If?o 1 ,q cr m z L co m
State or County License: C BG 0 (o 0 4a l
- - - _- --- -.-_ _, _ ..___..__— ...,..— - wnuuv.wn.a... u FeCIM ea.
SUPPLE
ENTi4LCOIVSTRUCTfOIV LIEN�LAW�INFORIVIATIOIVK��t"` ' `� t -;
DESIGNS
/ENGINEER:
Name:
_Not Applicable
rjG MORTGAGE COMPANY: _ Not Applicable
Address:_
/i3�{ TkcKE',2 CouZT Name:
Address:
City:
I Go2i 'J,z�cc State: � City:
Zip: 3
State:
So Phone: '77-Q [L6.c-zySS Zip: Phone:
FEE SIMPLE
Name:
TITLE HOLDER: _Not Applicable
I
BONDING COMPANY: Not Applicable
Address.)
Name:
Address:
City:
I
City:
ZIP: T—Phone:
ZIP: Phone:
I certify that
no work or installation has commenced prior to the issuance of a permit.
St Lucie C
which is in
structure,
unttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
onflict with any applicable Homeowners Association rules, bylaws or and covenants that
pllease consult
may restrict or prohibit such
with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration
in accorda
of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
'ce with the approved plans, the Florida Building
Codes and St Lucie County Amendments.
The followi
ig building permit applications are exempt from undergoing a full concurrency review. room additions,
accessory s
tructures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNIN
TO OWNER: Your failure to Record a Notice of Commencement
improVer
before
may result in your paying twice for
ients to your property. A Notice of Commencement must be recorded and posted on the jobsite
th
a first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing
work or recording our Notice of Commencement_
?LORIDAL
Signature o ontractor/Lice a HolderSTATE
Signaturner/
see/Agent
O
COUNTY
F J-7-,LLCCrc
STATE OF LORIDA
COUNTY OF S7, Lucir
The forgot
ig mstrum nt was acknowledged before me
The forgoing instrument was acknowledged before me
this 12 c
ay of GueccST 20/L-by
this 1Zday of 4a6aSi 20/(,by
-rn#41 Jam✓ a6s
J o /-hA✓ J'/,t-" SS
7(Namerrsonwledging)
(Signature of Notary Public- State of Florida )
(Name o p
arson acknowledging)
(Signature
of Nota Public- State of Florida
Notary )
Personally
(nown / OR Produced Identification
Personally Known I--,' OR Produced Identification
Type of Ide
itification Produced
Type of Identification Produced
Commissio
i No. (Seal)
Commission No. (Seal)
,°u4• SMETETREAULT
MYCOMMISSIONOFF92
EXPIRES: Seplember 13.2019
MY COMMI
SSIONIII FF 902Revised07/15
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