HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPQCATJON TO BE ACCEPTED
Date:
SCANNED tk Permit. Number: 3 - 099
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lh-1 OWN110 hirip rnlint%
RECEIVED.
Building Peirmit Application
Planning and Development Services MAR 34 7018
Building and Code Regulation Division ftmitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 Y\ St. County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT -LOCATION' -
Address::. 6'67--=--Ah—uL- L-GrA- -ii*, V1 Li aig &2
Legal Description:
AJ IA
Property Tax ID #: � CDQC)9 6 0 Q Lot No
Site Plan Name: Cf-AAAr(l rX�W- PA64�Block No.
Project Name:
Setbacks Front_ Q_ Back: Right Side: •Left Side:
DETAILED DESCRIPTION.'OF WORK;
ft� 6% ke pi'd n
Sin Id e
CONSTRUCTION INFORMATION:
Additionalworktopenerformed under this permit— c I neck all apply:
CJHVAC 0 Gas Tank [:]Gas Piping Shutters Windows/Doors
I
Plumbing Sprinklers, Generator Roof pitch
11 Electric 1] 1:1 0130of
Total Sq. Ft of Construction: SQ. Ft. of First Floor: 16 09
(2
Cost of Construction: $ 0") iSewer Li Septic Building Height: .3
Utilities:
OWNE R -8SEE: - ...-CONTRACTOR:
av/G n
Name:. i WCc
Name WkAnh( CC*A)P— M6W! -P—
Address: qol'T/us�
Company: SIPAk-e- uJi4e . �11G
City: & Ocefce' State: F1
Address: P, c) b0c
Zip Code: :Sq q � 6P _ Fax:
city: State:
Phone No.
Zip Code:_ 1395 Fax: -%3 -61fa -m 61
E-Mail: I
Phone No. &52'g&w- fac>C4
Fill In fee simple Title Holder on next page If different 1
E-Mail: )ILA LnLwv. - C-0m
from the Owner listed above)
State or County License: 3(20p
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIENIAW
RMATION:
Utbit2imtK/tweilmtew _ Not wppllcaale MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable I BONDING COMPANY: Not Applicable
Name:
Name:
Address:
j Address:
City:
City:
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 County makes no representation that is granting a permi
which is in conflict with any applicable Home Owners Association
structure. Please consult with your Home Owners Association anc
In consideration of the granting of this requested permit, I do her
in accordance with the approved plans, the Florida Building Code!
The following building permit applications are exempt from under
accessory structures, swimming pools, fences, walls, signs, screen
WARNING TO OWNER: Your failure to Record a Notice o
improvements to your property. A Notice of Commenc
before the first inspection. If you intend to obtain finar
commencine work or recordine vaur Notice of Cnmme
Will authorize the permit holder to build the subject structure
ules, bylaws or and covenants that may restrict or prohibit such
review your deed for any restrictions which may apply.
by agree that I will, in all respects, perform the work
and St. Lucie County Amendments.
lotng a full concurrency review: room additions,
Doms and accessory uses to another non-residential use
Commencement may result in your paying twice for
Iment must be recorded and posted on the jobsite
Jng, consult with lender or an attorney before
Nam
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFF L)I Y-,,
COUNTY O _ A
Vi
The fDr9olng instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of j (A Ir h . 20� by
this — ' day of If'`U rdl . 20JS_ by
Name of person making statement
Names a of per on making statement
Personally Known_ OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification }�
Produced 11 irGrlrtf.A` I i tr � Ww)
Produced 1)e_rsn a (1lf f`iilwo
YW
(Signature of Notary Pu ' - State dModda) .
(Signature of Notary Publi - ate of Flori )
Commission No.
Commission No.
it, Notary Public Stems of Florida
_
NOW I.itrlS soft of Florida
Victoria Laws
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Oediliniii�ionGOt197751
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DATE
RECEIVED
ICc
DATE
COMPLETED
Rev. 8/2/17 ` A