HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEIL6 r'OR APPLICATION TO BE ACCEPTED
Date: <P4 Q o ` �� Permit Number: d 5 1
SCANNED
BY
RECEIVED JUN 26 2017 St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT APPLICATION FOR: {alurn���rr 20�o r� t o.� aMOQruE NonnE
PROPOSED IN PIR-O.VEM. E�N a LOCATION:
Address: oLD FrR9-2) i=T P�rslct= FL �yq�c
Legal Description: AvorJ AC40rZ Sl Q - kJNII- 4- �A?e, @ I-crr l3 LkLks`\
Property Tax ID #: Zo3 fro - coLAl - moo - g Lot No. (3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
';�14S Ak .0ay4&fl.i6F- CZnL-t.FIs, AIvr"-, orJ
_Mechanical
_ Electric
A NMa�Cb\LF wlo ivy
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: 1�1 SD,
Cost of Construction: $ I`l7Gom • 6v
_ Gas Piping
_ Sprinklers
au tnat apply:
Shutters
Generator
Sq. Ft. of First Floor: _
Block No. G.
i•
Windows/Doors
Roof
Utilities: _Sewer _Septic Building Height:
OWNER/LE-SSEE:
CONTRACTOR:
Name '_kF�2ti. :'Aiho g
Name:' fi,!
Address: (Sqo FFA- (1-Q
Company: A4v�< Ts1 L
City: Stater
Zip Code: Fax:
Phone No.--)
Address: Sw W" -
City: V'v r^pa.�o �c3c-v,a Stater,
Zip Code: 33o6S Fax:
Phone No -z2i.o
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: Not Applicable
/ — PP
Name: -1^ y
MORTGAGE COMPANY:
Name:
`
�( Not`Applicable
Address:I.'zso r4A,.,oRF S ra.,+:-
Address:
City: State: 7L-
Zip: 3aa69 Phone_ 9S'1- 9ss .
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: --A_ Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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, consulf�t�7 rider or an attorney before
commencing wDA-oryour Notice of Commencement./ /
i
Signer/ L see gent
, rg'na ure of Conlrator/License Holder
STATE OF FLORIDA
STATE OF FLORIDA'
COUNTY OF GC -LID A ri r!>
COUNTY OF rz, r2 c2 sa n g
forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
_The
this day of —rx�n r= 20_n by
this � day of S�N� 201 i by
�bL'iN .Xr lj 22
= 1r �JfL2R�-1
(Name of person acknowledging)
(Name of person acknowledging )
`,---7
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known � OR Produced Identification
Personally Known 4-, OR Produced Identification
Type of Identification a"+"uti
+°'m ., o MILLER
Type of Identification zskl!! ;° ALpNMILIFR
MMANON#FF
Produced MY COMMISSION i FF 195499
Produced MYCOMMISSION-IFF195499
!
y 4, EXPIRES: May 5, 2019
4111,,V(S@
N, o� EXPIRES: May 5, 2019
"Eav�oa Budge)
Commission No. mru BudgelNotary servker
Commission No. (swyro Notary senkee
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