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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COM LETED FOR APPLICATION TO BE ACCEPTED Dater � 3a Permit Number: Il li T; z_ --i Planning and Development Services Building Permit Application' AUG 3 0 '1018 Ruilydinq Lind Lode Requ!ation Division •.ucie County, Permitting i 2300 Virginia Avenue, Fart Pierce FL 34982 --- — — �� II Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential II ii II . ;ill �Df-4�•L1`�}ITt�-I?-l:?16jf"!t1Ttn'�1;-RC}�: -r_..:=n-.�s��r:�:—.��;:;�- .z;l:�,��.�.-_.,,:��-s",-r.�,=,-�!�.In-.-r '^ f��l PROPOSED IMPROVEMENT-LOCATION: Address: &5"3 II Legal Description: ViYC`uf II II iJ! Site Plan Name: Block No. Project Name: �2LuacN-) FI U11L - ' — - L)CILN. - - I\ISI IL JIUC: LCI L JIUC. II -r-�.i.. in i --� '- III LOLI/-%ILL.L91l LJi..Bl6f til JIV UI V U ii=.. 6i. Vii? 1r 51�, EM 0 _ 5 y III CONSTRUCTION INFORMATION: (j I€ Additional work to he nertormed finder this permit—c_herk all that apply: li ilk :! I 'I ai 1� i1i LSI-IJAC. "-Gas Tank _"Gas Piping. uShutters I,�Wiidows/Doors Electric 0 Plumbing Sprinklers E]Generator Roof 3 �� Roof pitch Tntnt C� pt n; C.. Ct ..F C'r + pinnr. 11 II -s i + ., a Mcg " 1 1--IIa1..s: 1 1 I +•- L.+. t-tJ3L(•/I t onst uction:•2 6/ uLi 1L.1 1_� �cwcl _J Lit uuiluil Ig 11 ig11L. II F SLE -Name I -Name: n•• v+�S �,2 Address: _5W Company:"5 tb t o �- C'ity t�l�l Stats:E` Address: 30 SE i/t�oa C_c`c ii) Zip Code:a�j 6'Sj Fax: ' City: L State: W •rllai 1 No. � Zip Code: (il &_,Mail: � 'I .. � -Rh©nelNn '77 — 9314 —,X& Fill=�n-fee-simplie Tit1e-Holder-on-next=page-(`if-different- E-Wail1J t=�' �f c from the Owner listed above) State or County License: CCC e11 Col li -� ----� -- __�-�_---_--_---�-�----- _-..._-_• ---------s- ----�-� -- -----------��---�-�--- �--,-----• 11 Sl_1PP1_FMFNTAI . (]NSTRIJ('TFON®I_I:FN 1_A\IV IN�FCIRMATIO:N_ - - ____. I DESIc�NER/ENGINEER: fir Not Applicable nnnRTlrnrE rnnnpnniY• Not ppplicWblp I �I I I If Addr_es;: �.ddr�ss: i II ,.. 11 sll I.ity; �iaLc: ity: aiaie: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable II I Address: Address: I � •'_% =itY• ii r1w...,,,,. �:._, n4,._�. i tt I-Hone. ' mllJ. 1 °!t -OWNER/ZONTRACTOR A-FFIDVIT: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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure -- - -i Ir i'- i,}tiTii T"WiT ;MV mil tl„rntiiP Hr.-if-r- ,„niiiPrC i.VZPrintir,ii r „-- '.iia\niG Or n-- -,lvP,i:.r------rni w r---riff -- II structure. Please consult with your Home Owners Association and review•your deed for any restrictions which may apply. II In consideration of the granting of this reauested permit; I do hereby agree that I will. in all respects,perform the work II II in accordance with the approved pians,the Florida Building Codes and St.Lucie County Amendments. g .." -accessory-structures,-swirrrming-pools,-fences,-wall',-signs,-scre-en-rooms-andaccessory 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 -----� ._ ,r_._.. •.-�----i - -i_.._:._ r:.--•-- ..li. al- I-'--i-•- - i--t---- iiiSiiri:i if lfi iii ir.ii ir. iii.iii ri..i if i1HV i."rii ie i= -- II commencing work r recording your Notice of Commencement. H III I II Signatu__e_of_O nerj_Lessee%Contractor_as-Agent:for_Owner _Sign at '_ _of_Contractor/License:H.older STATE OF FLORIQA STATE OF FLORIDA' if i COUNTY OF 5kCOUNTYOF 3; II I The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me II II I rhl?j0 ri;!v�{ 4`^"7 �n ti" thic day of 7Q by II sli 11 d �� V SSJbn m O uss I °all Name-of-personmakitig-statement -Name of-person makingstatement Personally Known OR Produced Identification Personally Known_g/OR Produced Identification Type of Identification Type of Identification if i Produced tF l/ 0A, Produced II ILIN ii c o I XQ .ii 11 �(�ignatur--rof.NntaryrRu ic--.:%St-at-erofrFlorida,) ,(S�jgnature,of,Rota ry,Rubli 6 JStAe,of,Florida,) Commission No. '4 { o lvo (Seal) U EIWNAMpRIEGIVENS Co mission No.MY coMMISSIDN#GG 022 23* EXPIRES:December 16,20 0;e•••o Bonded Th.Notary Public Unde dters YP Q�Y ida ! II I RF\/IE\A/S I FRQAIT __ ,-_ _R\/ItQR P1 4rVC I \/Ff;FTATI(lnl IRCIMPibfc� F Jr I II MI INITCD I DF\/ICIA/ I DC\/IC\A/ DC\/I C\A/ I DC\/I C\A/ � \/ C\ � i � If I .. .. ..� ..�. i ..�..�.. '�� �`EkIvycom issi6ffml �Yloo It ii0 it U1�IE II !I �1 � �� iI DATE COMPLETED Rev. 8/2/17 II If