HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED di 'S
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Date: ���lj�� Permit Numbe" D
BYCAV
• MAY 2 2 2018
Building Permit Application Permitting Planning and Development Services 9 Department
Building and code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 46 i 1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED 'IMPROVEM'ENT LOGAT.ION:
ISZZ PoiNct!ANA c 1 . tT �l�;R.�-E iL__, ygsl
Address: � � 3
Legal Description: MAPOW0,00 oricr O WIL L-O yy�//� i0
C • 17 Ate} ,r0R 1051 - 10C46 . 3`� SCE " •
Property Tax ID #: 13; `{ - 50, 3 - 001 Z - 000 O Lot No.
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Site Plan Name: 5poti &V 0 U 2 cm Block No.
Project Name: 5O0NGrv'13 'yIZGtj
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
�/f/ ST��/i9-T% o�v or A ST4N0' 73 Y (G-/V 6/ � 7-0R
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CONSTRUCTION INFORMATION
Additional work to e e orme under this permit - c ec a apply:
�HVAC In
13 Gas Tank ❑Gas Piping _ Shutters ❑Windows/Doors
LQJ Electric 0 Plumbing j []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: IV161 S . Ft. of First Floor: "IM/4
Cost of Construction: $ 90� 0 I Utilities: lo
Sewer [ Septic Building Height: /01
OWNER/LESSEE:
CONTRACTOR:
Name 9I401 5 P01V 45N 6 cJ G
Name: 6U y S. f't1
Address: Q 1 zZ AOI NGf 6WA CT
Company: G. S ► 12n O0 KC ELE CT%1l C
City: ley n"EA G E State: FL
Address: Ze8 GA ST IA09 600- Qk 1 V E
Zip Code: 3q q51 iVIA
City:y&,,%o 6614 li State: /�` L
oFax:
Phone No. 772 ' 87 - 613 z
Zip Code: J?Z?(O1) Fax: 7 7Z - 7 ag ' z _YY9
E-Mail: Nf A !
Phone No. % Z- 60 S
Fill in fee simple Title Holder on next page (if different
E-Mail: 6 6/V (al COM G A.ST , N B
from the Owner listed above)
State or County License: CC % 3 00 61 ZZ
IIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. II
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER ENGINEER: dk- Not Applicable
MORTGAGE COMPANY: X Not Applicable
Nam
Name:
Address: I
Address:
City: I State:
City: State:
Zip: Phone: I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: YNot Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
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 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 intenld to obtain. financing, consult with lender or an attorney before
commencine-work or recording vour Notice of Commencement.
!*a _z ftoom � mr. J ft. S
Signature of Owner/Le ee/Contractor as Agent for Owner Signature of Co tractor/License Holder
STATE OF FLORIDA ,,//�� . I STATE OF FLORIDA ,,[[��
COUNTY OF �/CuaP/t COUNTY OF /CuaP�r
The forgo' g instrumen f was acknowledged before me The for og instrument was acknowledged before me
this 1Way of 20 / by this y of 20 a by
1
(Name of person acknowledging) I (Name of person acknowledging)
ry PuTilic- State gfFlorida )
Personally Known OR Produced Identifii
Type of Identification Produced
V pV
irsf. WILLIAM SU
Commission N Q
tulY COMMISSION 36
EXPIRES: August 28, 202
Revised 07
(Signature of Notary Public- State f Florida )
n Personally Known OR Produced Identification
Type of Identification Produc
l Commission No. ;;+A�; WILLIAMS RG N
I OMMISSIO;'� 136489
EXPIRES: August 28, 2021
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