HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB E INIFMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l 11(22 Permit Number: l ��
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Building Permit Application RECEIVE®
Planning and Development Services FEB
Building and Code Regulation Division . FEB -4 2016
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP.C}SED INI.PROVEMEfVT LOCATION
Address: 001( S d `h1 IN, bbq
Legal Description: c%# WiNoS CpAjoo A07- Go 02
Property Tax ID#: �f rb Z - 30K- DC)W_000-/ Lot No.
Site Plan Name: M Lys- VA-siv r- Block No.
Project Name: G J(_i/-r tiC'
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;OF VV.ORK r
.S 1�1
CONSTRUCTION INFORMATION _ ,r
._.. _
_
itiona work to e performed under this permit-check a app y:
1_1HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
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Cost of Construction:$ ZHO� Utilities: _Sewer Septic Building Height:
OWNER/LESSEEsn i CONTRACTOR
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Name ■�+1 _TLVAIN I- 1 Name: IGI�'Y ppt7G✓/
Address: 32 LoGuCf A4C Company: l4N5;6N BL-ACA aw/ Lrj
City: 6?05t'ar-� State:_ Address: 1340 A/W rE12F_
Zip Code: S-341 2 Fax: L12-'17wf City:�","AVIT State: r2
Phone No. 2M" *77&t Zip Code: 3L(54A Fax: LR Z-cl 7K y
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CGC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIQ'N LIEN LAW [NEt 'RMATIDN
_.. . .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: StWQV'� J"'noC'0_!uL Q.E - Name:
Address: I VSo �59'tl St (\of4 $tame, 1 o% Address:
City: State: Flo City: State:
Zip: 3?a'1 o Phone: 5 33—9 000 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 thepermit 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:Yo r failure to Record a Notice of Commencement may result in your paying twice for
improvements to your pr er1;y. A Notice of Commencement must be recorded and p sted on the jobsite
beforeMnnx
fins e- . . you intend to obtain financing, consult 'th lend ora attorney before
com or or cdi our Notice of Commencement.
s
Sig4ture of Owner/LVAgen Signature of Contractor/LiW111211d
older
STATE COUNTOY OF ORIDA COUNTY OF FLORIDASTATE OF
The forg��g instru was acknowledged before me The forgging instru e t w s acknowledged before me
this�'rda of e Q(Jri 20 Eby this day of �u� 20 �by
14,0
(s✓ 01 i�6
(Name erso c owledging) (Name of r ack edging
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(U
tary Publi tate of Flori a) ((pe
ure of Not ry Public- ate of FI ida
Pn ORProduced Iden ication PJKnow OR Produced nti cation
Tatioonn Produced Tion Produced
1h S7aLi
Commission NJ ���`�-�. •.(Seal). — - Commission No
JOHN LEE TINNEY ••`a'r''a"'•. JOHN LEE TINNEY
•lPPYPf b•4 ;O4P U'4'1'
NotaryPublic-State of Florida :?. .o: Notary Public-State
3-W• My Comm.Expires Nov 15,2018 ='• My Comm.Expires Nov 15,2018
Revised 07/15/201 � �;F Commission#FF 165316 ,op°;� Commission#FF 165316
Bonded through National Notary Assn. Bonded through National Not Assn.
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DATE
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