HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ro
- 111111111b SCANNED RECEIVED NOV 152016
BY
,M�� St. LUde Countv
Building Permit Application
Planning and Development Services ILI Q Jr- oc
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resi Aet
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow ilt the end of line' C... K, V. III
PROPOSED IMPROVEMENT LOCATION;
Address: 04_�154fJ -DYL-t v9- A_ZS5- 'Cc>Mvnc)n u-,— 0--r-on
Legal Description: I15L.4rj0%A -11rCfVzX> oy=��,3 (Ott fit-0
1
Property Tax I D #: JiS-C2 -66?_ -O&o 7_=-�� Lot No.
Site Plan Name: I Is LA� 0 1 a Block No.
Project Name: L,; L-orr-o I&
Setbacks Front AJ& Back: _L4� Right Side: _t!f �A, Left Side: __E[&
-DETAILED DESCRIPTION OF WORK: - . 11 1 _. I - III
I-WAr-l(J4 A(voifiw Vmi,-W6 6N tLi-ri+
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CONSTRUCTION INFORMATION:
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[1HVAC Gas Tank
E]Gas Piping
Electric Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ S-10c) _00
Shutters OWinclows/Doors
Generator 1:1 Roof = Roof pitch
S Ft of First Floor:
Utilitlesli Sewer ElSeptic
Building Height:
OWNER/LESSEE-
CONTRACTOR:
Name_i5L�ArrjoiP,-_d- cotvi,�o A."N
Name: /111"14*9z- 4000011W/V
Address:_9S-Dn 5 6/� -DreAVE- Zei?
Company: Alelm!� �a
City: -ya(Tev -F_&-Aa44 State: -E3L-
Zip Code: 3q9lr'7 Fax:
Phone No. 71
Address: 1-7Zo AJW rnEg2j21a.1_ /Avt
City: s4m-eLr- State:__FL-
Zip Code: ,?4,q4!J Fax: /,�93 'Z -Ooq
PhoneNo; -77 -4 - (241-7- - oC-A Q
E-Mail: J5Gkr-v31A 10
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:-
State or County License: QC, IS_(),1RLJ35L
ii vaiue oi construction is $zt)uu or more, a RECORDED Notice ot Commencement is required.
I
I
SUPPLEMENTAL CONSTRUCFION LIEN, LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: _ Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address:
Address:
City:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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
improvementstoy ur. - 'O'Ice of Commencement mustbFer cord ,cdl yan posted on the jobsite
before t irst 10 .)l Vointrend to obtain financing, co e ai'n attorney before
Vou
com =ncin 9 r �05vour Notice of Commencemprit.
S
Signatt.rre of Owner/Lessee/Contractctrz��� TigCatdre of Con(ra �/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF -3r COUNTYOF _5;�—
The forgot . 9 instrument was acknowledged before me The forgoing instrument was acknowledged before me
"My of '001Z 20/e,/-by thls//'e�avof 20,�Zl,
this I _ by
(Name of person acknowledging) (Name of person acknowledging)
(Signatu-r-e-oT Notary Public- State of Florida (Signature -of -Notary Publ-ic--State oTFForida
Personally Known / OR Produced Identification Personally Known wl�_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.
Revised
ANN M. GAUMOND
EXPIRES: December 7,2018
Commission No.
ANN
EXPIRES: December 7,2018
Bonded Thou Notary Pubrc UndeAwlem
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