HomeMy WebLinkAboutBUILDING PERMIT APPLICATION12=
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 27, Permit Number:
.j 9 0 2kh
SCANNED,
o
0 2018
4q%r ��If" 8 1 su Application
Perraitting
Planning and Development Services I Department
Building and Code Regulation Division St' Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: iT1 o Select from dropbox, click arrow at the end of line
P '090IMPROVEMENT �-OCATIOW ROP
Address: WE: Md-V -34 01
,I ( mod ertic (o ho
Legal Description:
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Property Tax ID #: fiat IZ-41 QC� (n 9 0 It, O 25 Lot No
Site Plan Name: C[-1DMr(J/ CQUE 1h6ha�11wi WN C Qrld& Block No.
Project Name: i I
Setbacks FrontjL_ (Back: Wight Side: Left Side:
DETAILED DESCRiPTION"OF WORK--
Mo 6, k, �,Gvw_ se,�ue �r- -zor� cmrripi6n
Sir\ '_�d e, 110ne-
tONSTRUCTI 'ON INFORMATION.
Additional work to be nerformed under this permit- c ec a app
0HVAC 152as Tank ❑Gas Piping Mutters ❑ Windows/Doors
Electric MI'Plumbing Elprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: So. Ft. of First Floor:
SS-0 USewer OSeptic
Cost of Construction: $ 6 Utilities: Building Height:
OWN ER -.V LISSEE: -
CONTA- -OR:
Name WkAnfKj rrl]9_
Name.-S;�O_��
- LicA5
Address: .1
-T. n
Company: 4�e wic
4e. sF
City: r-r^ ok e4( State: n
Address: P. i!) lox dtkAM
Zip Code: Ll & Fax:
city: '�.aic laKe- State: F
Phone No. '737 'M-t13olcl
Zip Code: _'00339MI Fax: %3 -696 -02 6 1
E-Mail: 11
Phone No. &&-- fbf G'_ R-0q
Fill In fee simple Title Holder on next page (if different
from the Owner listed
E-Mail: J&n Laws SM w6mai(- com
State County License: (2 0 n
above)
or .3
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
.SUPPLEMENTAL CONSTRUCTION LIEN'.LAW INFORMATION:
:I
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: !
Address:
City: State:
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
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 County makes no representation that is �rartting 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 Owner '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 1 will, in all respects, perform the work
in accordance with the approved plans, the Flori a 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 Ref ord a Notice of Commencement may resuh 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 Ito obtain financing, consult with lender or an attorney before
commencine work or recordine vour NnticP rif CnmmenrPment_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .
STATE OF FLORIDA
COUNTY OF f-A,
COUNTY OFF e1 I �e
The forgoing instrument was acknowledged before me
this day of o�fiJfA Ir< h 20� by
The forgoing instrument was acknowledged before me
this day of { a arch 20JX by
.
_ t _ .
SiG M. rI QMC-c-CLl 1
Iamo lanais t �
Name of person making statement I
Name of per on making statement
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I
Type of Identification y�
Producedr (a 11 k f 1�rni�r1
Produced 1�2 11 f tt� lV Y`tim,,in
I
�
(Signature of Notary Pu . - State lorida)
(Signature of Notary Publi - ate of Flori
I
Commission No.
Commission No.
Notary Public State of Florida
VictoriaLaws
P of iida
OdatnariM6819"51
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17