HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IaI�I1 b Permit Number:
RECEF 7-D DEC 0 03 2016
• I
Building permit Applicati®n
Planning and Development Services
Building and Code Regulation Division
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
VAC
PROPOSED IMPROVEMENT LOCATION:
Address: 41 Hi9AJ d yA
Legal Description: Epl3/t/IS/� /.Ak6.5 Cot/NrAV CL U/3 VILLA6:9 1-zZR9irH0Lb 6-S 07-Y5'
(09 2381- 6 :30 TWHT PR,eT OF SEC AS s1400M /A\ OR a3?9- (37 LvT W Hoc/ a'/A
PropertyTaxlD#: - - �3o`'i11�c�o�1-ods'-5 Lot No. /
Site Plan Name: Ro H'C US Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
J+IC FX/j(,T AE_P4t►CL hEuT- 2"5 T oN 14 S6-,5R
19lN # fiHIT,3617 STfiA1j_-7 i
G�U # /ZPI 30ff'17/h/19
PJ0 te`' Gu V0
CONSTRUCTION INFORMATION:
Additional work toa er orme under this permit-check a appy:
HVAC E] Gas Tank DGas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 1167., GG Utilities:cnSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name I-AIJRH d PAUL PO I-JZ U s Name: b-I46W-1J
Address: 1 1Y01J t Oy1f Company: 11Z-17L-
City: CaR Y Pi c RC E State: F- Address: a 5#0 S R/L/7.0—y Ti-
ZipCode: 3#951 Fax: City: lyv-cT P,44" 81_�wcw State: F2-
Phone No. 77a- 579- a(o$Q Zip Code: .3 VSI Fax: ,!5 (0 -
E-Mail: Phone No. 5,46 11,3 3 - a/9'7
Fill in fee simple Title Holder on next page (if different E-Mail: P6,0y/i5 �ZTIL/�C CtJi
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
h � `
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 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 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 ff'r I pection. If you intend to obtain financing, consult with lender or an attorney before
comme Kg w rk or recording ur Notice of Commencem
s
_Signature ofcaner/Lessee/Agent Si tura of Contr ctor 'cense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF r - 73 COUNTY COUNTY OF . �
The forgoing instiument was acknowledged before me The forgoing instrument was acknowledged before me
this"_7 day of ilf 0 20 Eby this —/ day of 1� tf 20 _o�oy
(Name of person ac ow g) (Name of person acknowle
(Sig re of ar Public-State of Florida ) (Sig to No a ublic-State of Florida)
P sonally Kn w OR Produced Identification ersonally Known OR Produced Identification
ype of Ide
nti 'c tion Produced Type of Identificatio Produced
Commission No. (Seal) Commission'No. (Seal)
tuoa"aolNaStieloNept,a
t� es�o•
'°„' JOHN EDWARD GIFFORD LI 10gW9�a0 S3FIIdX3 ;opoti!,0,*
4s. .
`` LetZLOdd#NOISSIWWOOAW =.s �'r;=
Re I7./�5�'�YIMISSION#FF077427 daO��IJ as
" ;ld Atld l.•••
VM Nun k.
(+07)398 015ZL—----------
FloridallotaryE ervi.."
REVIEWS G�-• SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS