HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 * aq' ( Permit Number:
3 �� T�� Is
SCANNED . RECEIVED
BY
tit I O
Burlc�Ift PAR it Application . BAN 2 4 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V "
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Property Tax ID #: 3N0 Z - Lo 10 - 022 0 - 000 - y Lot No. .S _->
Site Plan Name: SSA& En-krOfi52S __ Block No. _22
Project Name: 1 h AQ 2—ne (j2ri,5& S
Setbacks Front 30.2 Back: 1-16.97 Right Side: I2-31 'LeftSide: 12-S
►��-� I y (2s
itI nal worKtober)ertormed un erthispermit-checkall apply:
LYJHVAC L_l Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
[20ectric Ziumbing Sprinklers 11 Generator Roof
Totalt Ft of Construction: 7 S , 0 S . Ft. of First
j Floor: 2530
Cost of Construction: $1- 0 % t o00. 00 Utilities: Sewer i v Septic Building Height:
i 'CAS SC=J' I� All,
OUVNER/LESSEE , a
,.a.:. .
Name �� ENmz P2 LSES Lr L C
Name: -"'Sul io
Address: Po 66>(-1319$
Company:-3-C ti n5 C(.A'C.i�,�1 or�1�t
City: 'Pi f re e. State: ri..
Address: 5D1 {� W e r elau sw
Zip Code: ?N q 19 Fax: -1-1 2N e) - 5'$7 y
City: 1 'e; -e State:a
Phone No. �11Z - i - 2H 0
Zip Code: 2>4973& Fax: 7%a - ayq_ S5t7
E-Mail: 21
Phone No. 1i Z - 51 2Y�0
Fill in fee simple Title Holder on next page (if different
E-Mail: OCO Car; 71 99 rzi o (. COL-1
from the Owner listed above)
State or County.. License:
If value of construction is $75uu or more, a KMUKUtU IVOUGe VT LVnuntlm cn�cn� �a cyu..c...
IM
rSU:PPLEIVIE�NTAL�CONSTRUCTION L`IE aLAUG
DESIGNER/ENGINEER:. _ Not Applicable
Name:
J.
Address: 9 N 6i Faae . a nu Q
City: Lweio I State: F
Zip: 1.4°i$3 Phone: -7-7 2 - St15S- MI6)
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: n 11-LC,
Address: o box 1�1�
City: arT :,frC4 510r1 da
Zip: 34q"101 Phone: -712 - 5')'7 - 2490
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: ✓Not Applicable
Name:
Address:
City:
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 acid accessory uses to another nori'residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.JA 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 your Notice of Commencement.
Signature of Owner/ Agent/ Less
STATE OF FLORIDA
COUNTY OF
�L-
TheMfring instru entwas
thisday of
MC
ame of person acknowledging
nowieage efore me
20 by
CI
(Signature of Notary Public- State
Personally Known OR Prc
Type of Identification Produced i
Commission No: ��"" °- MN
'�nmma I
Revised 07/15 2 1
)
ntification
REN/ISej''ELSEN
amiss n 7E FF 115637
Commission Expires
nature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for ing instru ent was acknowledged efore me
this day of 20jby
(Name of person acknowledging)
(Signature of NotaryPublic- State`of Florida )
Personally Known OR Produced I entification
Type of identification Pr
"' KA N NIELSEN
��a" n ya `,dr��
Commission No. ;? '4? Com ?A n # FF 115637
My Commission Expires
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE.
REVIEW
MANGROVE
REVIEW
DATE
I
COMPLETE
INITIALS
I