HomeMy WebLinkAboutBuilding Permit Application To: St Lucie County Permit Dept Page 2 of 5 2018-04-20 15:21:56(GMT) 17722063146 From: Holly Kulinski
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l 'O
Date: i"E —-- Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services APR 2 0 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST. Lu e Co ty, Permitting
Phone:(772)462-1553 Fax:(772)462-1578 Commercial R
PERMIT APPLICATION FOR: Mechanical 0
PRO
PQSEDI.MPRfiflVEIV1ENT-LOCATION:
Address: I(Oa o Nuj
Legal Description:)6C3C_?11CakVi( aPv,
Property Tax ID#: 3� � `0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'1 TAILEO:D.E�CRIPTIQN QF IIdOR[�;;
w-li-`iVq Fct uLP_7Y Ica IR- spit -syr
(�J 94) lit)K J hPAA- rrq ,k 9,A WaoORS'l rr,0 6p_� 9 k�r"C STS
CONSTRIICTIOIV INFORMATION. {
Additional work to be nerformed under this permit-check all that appy:
HVAC Gas Tank
OG
Piping _Shutters a Windows/Doors
aElectric F]Plumbing .Sprinklers FIGenerator Roof LJ Roof pitch
Total Sq.Ft of Construction: S�of First Floor:
Cost of Construction:$ l'�'1.CXR utilities: Sewer[]Septic Building Height:
OWNER/LESSEE' CONTRACTOR;
Name.yoy,e:� I Name: - S�,i�1irtS 4t
Address:l N� 2P � (. k Company:.
City. Ukrvti 0lieLl Stater. Address: Ilat '7�r� 2w�a .,r-
Zip Coded,qC`3 Fax: City:7d-ll,-tea}. � f Stater.
Phone No. Zip Code:34clI Fax.—
E-Mail:
ax.E-Mail: Phone No.`"M—x'1"1 sn(z n_
Fill in fee simple Title Holder on next page(if different E-Mail.QxQ zW,"&er4�_-TC e=D.,I (zlY
from the Owner listed above) State or County License: 0CC" 54,3Q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
To: St Lucie County Permit Dept Page 3 of 5 2018-04-20 15.21:56 (GMT) 17722063146 From: Holly Kulinski
PPI.E f ► ONSTRU... i N '#I Q MAO*
�DESIGNERJENGINEi:R: X Not A iicable .�:"�:-------___.__..
pP MORTGAGE COMPANY: )C_Not Applicable
Name: Name_____
1 Address-; Address:
City. Stater City: 5#ate:
Zip: Phone Zip: , .Phone:
FEE SIMPLE TITLE HOLDER, Not Applicable �{ BONDING COMPANY: Not Applicable
l Mame: I Name:
Address: Address:
City.- City:
l
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AfFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun�makes no representation that is granting a permit i Ill authorize the permit holder to build the subject structure
which is in co fact with any applicable Home Owners Association ru es,bylaws or and Covenants that may restrict or prohibit such
structure.please consult with your Home Owners Association and review your deed for any restri mons which may apply.
In consideration of the granting of this requested permit,I do hereby agree that 1 will,in all respects,perform the wvork
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The followingbuilding permit applications are exempt frrom undergoing a full concurrency review;room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential wse
WARNING MOWNER.your failure to Record a Notice of Corrrmenoernent 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 fiinancin&consult with lender or an attorney before
commencing.workor recording our Notice of Commencement.
Signature of Mvner/ ntractorr as gent for Owner Signature of Con#ractor/Ucense Haider
STATE OFF A STATE OF FLQFM
COUNTY OF� ; '►C" 4 ..� COUNTY{7f.
The# oin i rxierrt was acknowle a before me The
!Q dg rgorngins was aricnow}edg efore nie
thiday of 20-M by itlday OfC _.2D. by
Name of n.making statement idame of p ma ingstate,Tient
rsonally Known OR produced Identification Personally Known OR Produced Identification o
Pe of id ents anon
uCed�cation Type of Ide;
�(l l�1 t�'r Produced '�('+`= Yu�k�t n LL ro
Q ( ' nature of N Public-State of Florida g .
i5l nature of Nota, ubi.ic:State of Florid..a) �
9
qmission
No. (Seal) +�rmrrlis9lonNp. � 1 � �j {Beal)._..... _ __. j
1
REVIEWS FRONT ZONING �SUPEWSOR I PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW l REVIEW REVIEW REVIEW REVIEW REVIEW i
bA'PE
RECEIVED
DATEi 1
1 COMPLf M
I Rev.8/2/27
t s