HomeMy WebLinkAboutBuilding Permit Application Sep 08 16 09: 24a Grace Family Church 7728797423 p. l
ALLAPPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I LO Permit Number:
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Building Permit Appliaition SEP 0 8 201
Planning and Development Services
Building and Code Regulation Division Lucci idi ITTI my
St. L
2300 Virginia Avenue,Fort Pierce FL 34982 e County, FL
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: ���.J � �a GLrI
Legal Description: �\ Ll 21! e(:5- `u [�' l 1 D� �-D�" g (gyp &1 2
Property Tax ID#: L,--;.C} 1 'S - «I�(ro` C;O� Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left:>ide:
DETAILED DESCRIPTION OF.WORK:.:.
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check a appy:
❑HVAC Gas Tank []Gas Piping LJ Shutters ❑Windows/Doors
Electric LJ Plumbing ❑Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq.Ft of Construction: Sci.Ft.of First Floor:
Cost of Construction:$ SAO -0 O Utilities:L_ISewer ElSeptic Building Height:
.OWNER/LESSEE: CONTRACTOR: -�
Name PH�LLF C-0Z Name; Ci,V . SET-WC-
Address: LA-3b ( Company: -r
City: State:L& Address: /Tva Ave-
Zip Code: I t :A%O Fax: City: c Xtcc� Q State: /7—
Phone
LPhone No. Zip Code: Fax:-77P SL
E-Mail: Phone No. �02 - 3�� S(O g Z
Fill in fee simple Title Holder on next page(if different E-Mail:� -CJV-1E?SLS t7l�Ce�CtrJ+'nG 8-e_n_i1cen (2r� 00
from the Owner listed above) State or�ountr License: z1`
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 08 16 09: 24a Grace Family Church 7728797423 p. 2
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 TITLEHOLDER: _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 ar d 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 wi I,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 access.)ry 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 work or recording our Notice of Commencement.
ature of Owner/Lessee/Conti s Agent for Owner ture of Coni ractor/Licens Holder'
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L fr L'i �' COUNTY OF_ G Gl(ri
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this:S' day of it-'�?�, 20 j by this S day of_ .Se�:,7z�, 20 ii by
V
(Name of person acl5gowledging) (Nafne of person ac nowledging)
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$_gnature of otary Pub ic-State of Florida} ignature of No-:ary Pu tic-State of Florida}
Personally Known_LZOR Produced Identification Personally Knowrt L-----6R Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.j } ).Ss�� o� Y:;�Bi(NSeal)BONNIEMI.BOUVIER Commission No �����/ ro'�'4;'%JSeakNNIEM.BOWIER
. ' MY r •
* COMMISSION i FF 215891 MY COMMISSION t FF 215891
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'>le"",o�01 Banded ThruBudget NobryServiees *-'e"F.09BandidThruBudget NotiryServkel
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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