HomeMy WebLinkAboutBuilding Permit Application Oct 20 15 09:31 a First Choice Plumbing 7728797860 p.1
ALL APPU LEI FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number.
WNW
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)452-1553 Fax:(772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from.dropbox, click arrow at the end of line
'PROPOSED IMPROVEMENT LOCATION:
Address: all!A1 M °L - 9"N--C 9L Pc9r-*t �+Sk- LW 91 24MU
Legal Description: e.6CLC,i t_ sc C�1
Property Tax ID#:A_1k "5()1'0V4,5_-oao-E Lot No_.
Q3
Site Plan Narne: Block No.
Project Name:
Setbacks Front Back Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S
s\o,�\ .5 O Gat E�e.c, r c. w a• zr a o.. �,�
1..%x `ro 1� C'.Y\e--
CONSTRUCTION INFORMATION:
itiona wor to e e orme under is permit—c ec a app y:
HVAC 13 Gas Tank ❑Gas Piping Shutters ❑.Windows/Doors
Electric PCGeneratorlumbing OSprinklers 13 Roof
Total Sq_Ft of Construction. Scl.Ft.of First Floor:
Cost of Construction:$ 0 U C"1 Utilities:0 Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C Name:Tott GG
r.
Address: Company:
City:P&A !j' LState:'r'I Address•.ti
Zip Code:�Q U Fax: City: �"n
Stater
Phone Ncftla) Zip Code: % F Q-
E-Mail: Phone N -11 LA
Flt in fee simple TEtle Holder on next page(if different E-Mail: o
from the Owner listed above) State or County License: FC `COm
N value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
Oct 2015 09:31 a First Choice Plumbing 7728797860 p.2
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HO R: - _ _ Not Applicable BONDING COMPANY• ,Not Applicable
Name: Name:
Address: Address:
City: ��Phone-
I
ZipPhone: Zi{�: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,l do hereby agree that 1 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,
accessary structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TOOWNER:Your failure to Record a Notice of Comme cementmay result in your paying twice for
improve �toyour roperty.A Notice ofCommencement st be recorded and pasted on the jabsitebefor on.If you intend to obtain financing,con It with lender or an attorney before
Ifto / yfo'ol "'*'�' _
c mencincordis our Notice of Commencement
Si ure of Ow er/Agent/Less a Sig re of Contractor)-ce a Holder
c
S ATE OF FLOR / �� TA E OF FLORIDA
LINTY OF f L CO NTY OF
The fo oI instrument as acknowledged before me forgoing instrumentwas acknowledged before me
this day of . n Z, 70 by t ' of Gr�c� 25 Sby
n —7)[l
(flume of son acknowledging) (Name of p 'son acknowledging)
(Signature of Nqtary Public-State of FI 'da j (Signature of Nota P& lic-State of Florida j
Personally Known OR Produced Identification Personally.Kn( OR Produced Identification
Type of E entlficatiori roduced Type of Identification Produced J—'
0-2- an 1� NANCY LEE LAN �s an No.C� ;s; al) r'IgNCYZG�
Commission No. 14Y COMMISSION# EB34242 T4 `'c �Y CO11I q� fiOR
EXPIRES October 2 2 aor�' AXP
J407)37?3-0163 F10nd0NotaryS0rWCe.00m F�n�a�yo wetobar I 2Uo6��
Revised 07/1512014
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