HomeMy WebLinkAbout1601-0388ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCENTED
Date: Permit Number;
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34952
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:
T
Legal Description: F/Y [ .33 z ' !" a i dj a�
Property Twe, ID #• r � � c 000 ' lot No. a�
Site Pian dame: i A", WRILCH Bloch No.
ProJP.ctt Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�'w ��-� Fore z-1 -- � �
PAj*A6&-- Lit/ a- WITff 7 kw 146�—	e
CONSTRUCTION INFORMATION:
ALUILIU[IdiINUMLUUt� e(IUlIIFeu uIEuf2l1111:2PAZIIIif4—La1CL[icaaa[noplily-
ZHVA
Gas Tank FIGas Piping _ Shutters Windows/DoorsElectric l—1 Plumbing OSprinklers 0 Generator Q Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: S �. ` �� � __ _ Utilities Sewer Septic Building Height:
OWNER/LESSEE.
I CONTRACTOR.
Dame_ `_ 1
Name:
Company:
Address: 3 �I�
City: '#-. State:
Address: LI
Zip Code: Fax:
1
City: - Stater
Phone No. ? ;40
'�
Zip Code: 3 �� Fax:
E -Mail:
Phone No.
Fill in fee simple Title holder On nem page if different
E -Mail: A1';" ! 13 6 _ .. . ,L) -�
from the Owner listed above)
a F
State or County License: ,1+ Q ",_, 15
If value of construction is $2546 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE BOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 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, consult with lender or an attorney before
commencing workorrecording4our Notice of Commencement.
Signature of Owner/ Lessee/Agent Signature of Co ractorfLicense Holder
LIZ
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF wJ_/ COUNTY OF
The forgoing instrument was acknowledged before me
thisday of S 70 I&Y
(Name of person acknowledging)
(Signature otary Public ate of F rida )
Personally Known OR Produced Identification
Type of identification Produced
Commission No.
Revised 07
Commission 0 FF 908943
9ofttlad ThN1- Ksin ih4ufMC�gpp.;ti95.7979
The forgoing instrument was acknowledged before me
this �,clay of Y64—/ . 20 ,6 by
(Name of person acknowledging)
(Signatu&DHT tart' Publ' - tate f Florida)
Personally Known _ OR Produced identification
Type of Identification Produced
Commission No. r
7�(Seall-
CHRIS WOODBERRY
Expires August 12, 2019
Sanded 7htu Troy Fen IOUMG- 8WIMS-7019
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