HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE C8MPLETED FOR APPLICATION TO BE ACCEPTE'D--
Date: Permit Number: /YN _19/yla
MEWED
Planning and Development Services Building Permit Application JUN 6 . -7 '2010
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie 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
Address: U
Legal Description
LEWWRA W W_
WIVAR
3 IL - M
MW 'Ong
0
Lot No.
Block No.
011W
ACIanionarworK to De nertormea uncier this permit - Check all apply:
HVAC Gas Tank In Shutters
E]Gas Piping — OWindows/Doors
DE'lecir'ic 0 Plumbing OSprinklers 1:1 Generator E]Roof Roof pitch
Tota I Sq. Ft of Construction: S Ft of First Floor:
. C . os.t of C . ons . t . ruction: $ oo Utilitiesli Serr []Septic Building Height:
�s
01ITA X�a
"�i '-4
N a m e Yn �-A
Name: JO/ kuklu
A d d r e-ss: _. V13W
City: AL&K\ OA�_� Stat;!!a
Zip Code:,MSQ \'� Fax:
Phone No.
E-Mail:
Company:
Acldress:Z'�S' I, lcz_ 4-
City �r State-i--ka
Zip Code: Fax:
Phone No. !L-'
le 1'40
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E- M a) i I Z�Nw4u\-
State or County 3C_ense:7E;�1_Q bq(oOLA
IT.vaiue OT construction is:>A:)uu or more, a 14MUKULD Notice ot Commencement is required
d
N MA U G 0 NS A
55� �12 ;0,
DESIGNERIENGINEER:
Not Applicable
MORTGAGE COMPANY:
No . t Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
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 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 ma estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions Mich may apply.
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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
imp'ro�e,m nt, s to your property, A Notice of Commen ment ust be recorded and posted on the jQbsite
1:
bef cie h Eeef i r�� i nspection. If you intend to obtain finachecin , nsult with lender or an attorney before
g'
m t
-worf0r re�corclinjz vour Notice of Commence t.
corT) m* cing Xe .
�1. 'I / I U /
Ali -1
vrie,r/ Lessee/Contrtictor as Agent for Owner Signaturep �6ntractor/Licehse Holder
STATE�- OF FLO STATE O*rFL0,Q1DA
COUNTY OF.. COUNTY OF
The fo ing in"ent was acknowledgeA before me
this' -nay o 201L by
Nah?e of pe7making statement
.Personally known' OR Produced Identification,
:Typ6 of lddntifieation
Produced N
The forgoing instrument was acknowledged before me
this., y
6L day of._ 20&.b*
11�4ne of person making statement
Personally Known. OR. Produced Identification
Type of Identification
Produced N
(Signature of Notary Pu ic- St t (Slq2 ture of Ndtary Publi
BEV L. HADDAD Le BEV L. HADIJA15
to 0
Commission.No. My r,&�AION # GG 009363 C mmission No.
MY OWOSION # GG 009363
EXPIRES: July 6, 2020 EXPIRES: July 6, 2020
'Wded
Thru Notary Public Underwriters Bw*d Thru Wary Public. UndeWiters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ' .'
COMPLETED
Rev. 8/2/17