HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APP
Date:
SCANNE®
BY
Building P
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 /C(
PERMIT APPLICATION FOR: To Select
PROPOSED IMPROVEMENT LOCATION
Address: Zc t-:R 2 E 0 R G ZG FL�
Legal Description: IQ.e4zi_ve- et-1
i
13, 13 A 13 /3 li;�
TO BE ACCEPTED
Permit Number:
,mit Application RECEIVED
MAY 0 3 me
Permitting Department
mercial Residential S . , le County
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Property Tax ID #: R.�fwt. (� i�,�.1�"�' ^` 1' Imo` A 33 r 2_F40 Lot No. ? G
Site Plan Name: �s Z� jrnjis 1_4 i/sF Block No.
Project Name: kA S'P( 13 0TJLri `s/ fc
Setbacks Front-; Ba o_shte: --—Left Side: a5
I DETAILED DESCRIPTION OF WORK:
Ar�� 11o�s�. f1 a !Iwic�_ a.k y22,.E I.?e..-,L 7zuseF►• 70A 91 i_
5j'o ,,
2 i 4 S'S (�{ /}2aa rti<t.ci,.. v�� 5'ery
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CONSTRUCTION INFORMATION:
Additional work to ne rformed under this permit - check all t= apply:
EHVAC Gas Ta lc Gas Piping _ Shutters Windows/Doors
17771
SElectric Plumb ng Sprinklers Generator Roof S�rz- Roof pitch
Total Sq. Ft of Construction: I S's 6,3 So. Ft. of First Floor: 5 5'�v3
: Cost of Construction: $ -4v100 o Utilities:[] Sewer Septic Building Height: < as .tom'
OWNER/LESSEE:
CONTRACTOR:
Name iCA S h Mii2.r '�E 5/i.(A S H i 13A I-IZA
Name:
Address: C1�SA SiV/ -r4XR_%ErNr4 L-ri n46
Company: d N
City: RAT S7. Lui111r__ State: -C-IL
Address: t5-7a ( Ce�
Zip Code: 34 fl Kb 1 Fax:
City: T State j=_,
Phone No. `71 -) - ��'1 7 5 - 6448
``�1�r
Zip Code: _J`C9 �J Fax �2-�`(- R0j ZJ
,
E-Mail: Pt*r
Phone No. r
Fill in fee simple Title/Holder on next page ( if different
E-Mail: Eosc,G� I cc�
from the Owner listed above)
State or County License: ( 3
I
If value of construction is $2500 or more, a RECURDED Notice of commencement is requirea.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFO
MATION:
DESIGNER/ENGINEER: Not Applicable
ORTGAGE COMPANY:
.' Not Applicable
Name: _ou,t� f 3
ame:
Address: .Sy i Pa scat z,* D Q\ vc—
ddress:
City: P8Cr_-- State: ,t�:-
Ity:
State:
Zip: 3 zs 7 t Phone .7 -12- - 7 1, — 47089�
ip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
,Not Applicable
_
Name: kA5yAM10+-1 Y Stt�-s.++k F�t��
Name:
Address: �? W-� 4 s ry To R-Xiom 4q-&/f
Address:
City: oJLT sr• Lv",r- FL
City:
Zip: .'Phone:
Zip: 34 S Sr6 Phone: -71 -7 - 1-7 `I - 6
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby ade to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to tho issuance of a permit.
St. Lucie County makes no representation that is I
which is in conflict with any applicable Home Owr
structure. Please consult with your Home Owners
In consideration of the granting of this requested permit, I do
in accordance with the approved plans, the Florida Building G
The following building permit applications are exempt from ui
accessory structures, swimming pools, fences, walls, signs, sci
WARNING TO OWNER: Your failure to Record a Notl�
improvements to your property. A Notice of Comm
before the first inspection. If you intend to obtain fi
commencing work or recordine vour Notice. of Co .
:e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
deed for any restrictions which may apply.
;by agree that I will, in all respects, perform the work
and St. Lucie County Amendments.
going a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
:e of Commencement may result in your paying twice for
encement must be recorded and posted on the jobsite
nancing, consult with le er�r/�in attorney before
mencement. /�� A
Signature of Owner/ Lessee/Contractor as Agent for Ow er
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF Sk_ L_U G1c—
STATE OF FLORIDA
COUNTY OF S�- • L-U C,i<.
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
IB
this & day of MQrS_h . 20 l 6 by
this day of 0 -la r ►f % . 20$ by
ash � : �� L_ • � q�.,ra
�.,ol e ..�. ��� \
Name of person making statement
Name of person making statement
Personally Known OR Produced Identificatio
Personally Known --1 OR Produced Identification
Type of Identification
Type of Identification
Produced %A-444
rVduced
� �
1t CAW
�J1C�� LINL �Q�J
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida)
�.••
Commission No.� A
Commission N YN WDY
.:,.. G ORAWDY
,,
••! MY COMMISSION # FF1198558
IT
=•• �•? MY COMMISSION # FF1985
EX I
11 2019
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DATE
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DATE
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COMPLETED
Rev. 8/2/17