HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr racn rtfi"cT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 14-*lo-iZ Permit Number:
SCANNED MaIVE . D
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. . . . . . BY,,
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Lai• St Lucie County
Building ftirmit Application APR
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Planning and Development Services perSt. Lucip. r
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 c6mmercial Residential.
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
IMPROVEMENT LOCATI
Address: ds,�leo-, IncA
Legal Description: WUeA*ke5
PropertyTaxlD#: L1902L- ICA- 0S5k4 00-6--7 Lot No.
Block No.
Site Plan Name:
Project Name: Vo tPA-e-4 ' OT 'ZKN
Setbacks Front_ Back: Right Side: Left Side:
QUAILEU'DESC
)WOFWORK
TOO,000 `J Suqpy-� Pit
CONSTRUCTION-1N, FO, RMATIOW
u permit
ec a ap ly:
Tp- lidirtliispennit-c c a
Add itWnal work to e effo-rffie i�
S
pini�nhpu
0HVAC Gas Tank F !Gas Piping I Shutters Me rs windows/Doors
❑ Electric Q Plumbing PSprinklers ElGenerator Roof Roof pitch
S Ft of First Floor:
Total Sq. Ft of Construction: "n E] -- Building Height:
Cost of Construction: $ �? utilities. Sewer Sep
tic
Nam
Address: W-cZj. LJ.'M 'WeQk- �'96(0
City: "'n Vea-k State:
Zip Code: 3-30% Fax-.
Phone No. S'Sla
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of
N a m e: IDA -J I C& zndk-e /'
-T I 50,�r\,6QA /-Lc-
Company: ^3P%c- DQO� 0 0
Address: IScA :SW 6'G,1-t+.L-JAq
City:� 4 &% C� k( State
E
ZipCode: 3'0150 Fax:
Phone No. !:) ") Q- Q 9 4 "105 S'
E-Mail: 25=pie- d be kt au Q (+ A 0 d Cam
State or County License:
is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW7INFOR{MAT,ION
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: i Name'
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
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 prio i 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 frolm 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 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
i
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA /� I
I-
COUNTY OF IY�(1A �T j �� U !Q-W !
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 4n rr a , 204 by j
The forgoing instrurXient was acknowledged before me
this;Q day of �(� 20 by
(� a rb I .PI�� u� I
fDl • h_0 us
Name of person making statement I
Personally Known OR Produced Identification
T
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Ident�ficaion
Produced F ti(• L `,_
Produced -ir l IJV Li e- _
(. O - -P/i_V_,LJ
,
(Signature of Notary
��y „ CARQL A. PREW
Commission No. Notary I )stateof,Fbdda
Commiselorul FF 149300
My comm. expires Aug. 10, 2016
(Signature of Notary Public-
Commission No.
State of
Florida).
iiC pRf:W
Notel�ipl State ofFlo►Ida
Commission# FF 1491300
My comm. expires Aug.10, 2016
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REVIEWS FRONT ZONING SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
51 K �t8
ff
DATE
COMPLETED
Rev. 8/2/17
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