HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� 1 Nil SCANNED Permit Number:
1'�
! no �3
BY
s St. Lucie Countyi;.r=r�
V
Building Permit Application
JUN 0 1 2017
Planning and Development Services
Building and Code Regulation Division
PERIM-17,114G
2300 Virginia Avenue, Fort Pierce FL 34982
St. Lucie ounty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED,IMPROVEMENT'LOCATION:
Address: 9YA1 r, �Cc-'hsV iJr•�87J JEiJS6n� 1�EkcNF! 31r9J
Legal Description:_ 1,051ykwkyl K6,1w ok�%QSt =7 13Io05. 7 — Vw,* F7
Property Tax to #: 3S3S= 333-W 1 ' S•7c) -j;-
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
::DETAILED. DESCRIPTION OF WORK:
!z1J5 AA1, T.tarreTw:�,�vw1 t��ov�
CONSTRUCTION INFORMATION:
Additional work to pe ertormed under tispermit-check all apply:
LJnnHVAC Gas Tank ❑Gas Piping
_Shutters
Windows/Doors
Electric 0 Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: 5 Ft. of'First Floor:
Cost of Construction: $ �o%Sr% Utilities Sewer[ Septic
Building Height:
OWNER/LESSEE:`
CONTRACTOR:
Name `t• i 16k
Name:
it iS
Address: _ftlI S,oce'irtio.J:0-E7
Company:
9-0 6o ClZvCtroriLLG
City:TeojS6F/_&EAG44- Stater_!
Zip Code: ?'(9S'7 Fax:
Phone No.
Address:14,
D /,t/,G�:te/f�..Ljrbn �•
City: LOX.a
Zip Code:
Phone No.
tiA4tA eL State:'F/
33f7u Fax:
r& 5-0 Cf
E-Mail:
Fill in fee simple Title Holder an next page (if different
from the Owner listed above)
E-Mail: 5)re^LE.j Q Ao.+C.onS4-,t w cflay . C_V�
State or County License: CGC f M I S'W:
11
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
SUPPLEMENTALCONSTRUCTION, 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 TITLEHOLDER: _ 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 p�
In consideration of the granting of this requested permit, I do hereby agree that Iwill, 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
as
STATE OF FLORIDA COUNTY OF 54- � Lac C'e
The forgoing instrument was acknowledged before me
this AL day of M" 20 1'1 by
Personally Known OR PropcedIdentification.-�
Type of Identification Produced ILL 0 r
Commission
Revised
STEPHEf� aII ELTON
MYCOMMISSIO #FF17038a
.,.....,mhnr 2. 2018
s
ontractor/License Holder
FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 1IV dayof 201") by
Personally Known [FOR Produced Identification
Type of Identificatio
S-fEPHEfd C, 13hL.IUIN
M,SSION (59a110384
mzmnES Novomber 2. 2016
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