HomeMy WebLinkAboutBuilding Permit Application ALL APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Co
Date: ' , Permit Number:
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Building Permit Application APP 1 120%
Planning and Development Services PERr
Building and Code Regulation Division Lucie IT;nI ty
Si. Lucie Coty, FL
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
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PRbPOSED_(MP.ROVEMEIUT L0'CATION
Address: Tj TOO s DAN �°2' I�o ,TE Nov s�
Legal Description: 15 L_Pr N r)I rr. 0Q/N 00M 1N10#LA JN IT t'70 `b l2 l 19 7 43
1274 — 19-7 ,
Property Tax ID#: 415-OZ' 0U2_p160 _A00-O Lot No.
Site Plan Name: N11Z-5 Q1 Block No.
Project Name: A�?is�
Setbacks Front Back: //t' Right Side:/�//F- Left Side:
DETAILED DESCRIPTION CIF'W0
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hI I tiobuu S,WrL l�->r pl4CeM�, ( y winl�S �6r]71V6
CONSTRUCTIQN tN° FORMATION 3 r';
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itiona work toe e orme under this permit-c ec a appy:
❑HVAC 11 Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ I I LGUL7 Utilities"
_Sewer[]Septic Building Height:
OWN ER
/LESSE(, CONTRACTOR 5
Name Name: IV l 1
Address: `f Soo (XxAk J 1541 41 Company' t/1+c /1/
City: awSEN (j rf✓ Stater Address: 1-77.L) Ivor)
Zip Code: ?LJ 15-J Fax: City: ':; yu /l_r State
Phone No.(-77L3 -Sc g�_ ?9 YY Zip Code: &1r1 !f Fax: 61 z AR-1uL/
E-Mail:& lt�gq rM i aemV_" 0_NA1,M'..c 0 A—A Phone No. Ci Z-Opti O
Fill in fee simple Title Holder on next page(if different E-Mail:/u� k%y/ti�y .Gtr
from the Owner listed above) State or County License: ('G(' I t a3 c( l:z-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQ;NSTRUCTIQN LIEN LAIN INFQRMATIQN
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:" A9hnuJ5el I CRUS Name:
Addres 1'%lco NW Address:
City: State: fZ City: State:
Zip: 3 l7 . Phone• aSK J 7a!-7—�j'lol��_ Zip: Phone:
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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:Your failure to Record a Notice of Commencement may res It in your paying twice for
improvements to your prop rty. A Notice of Commencement must be record a osted on the jobsite
before the first insp ct' n f you intend to obtain financing, consul i le er r n attorney before
com in or r e in our Notice of Commencement.
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_Sig ture of Owner/ s e/ a Signa ure of Contract Lic se Holde
STATE OF FLORIDA � '/ STATE OF FLORIDA'
COUNTY OF �///v COUNTY OF �p�'�
The
Ing instru a as acknowledge before me The f ng instru wycknowledged before me
this of /L 20/�by this da740T6,_L
f 1��C 20��by
�1_"L dao�)i �a�cJr ;J
(Name erson c owle ii g) (Name of p on wled ing)
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(S' nature of otaryP -State of Flo da) ( ignature of k��p State of FQeification
ersonall Kno n OR Produced Identification P sonally KnoR Produc
Y
ype of Identifi a ' Typ f Identifed
"0.P,1, JOHN L N
JOHN LEE INN Y
Commission No. :ter°�. .`�z
Notary Pu tate of Florida y ��al Commission ypublic-IS Florida
CommxpiresNov 15,2018
yCommisExpi # FF 165316 My Comm.Expires Nov 15,2018
Gofnfn;ss;e FF 165316
Bonded through National Notary Assn.
Bonded through National Notary Assn.
Revised 07/1 Zr
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