HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPT D -, Z-0-V Y _-0 7 q'
Date: SCANPermit NL rIlDnO Li M go
NED rf%x
By
AUG 2 7 2018
Building Permit Applicati
Planning and Development Services Pern-titting Departi-nent
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
(PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PJ6?_
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;PROPOSED IMPROVEMENT LOCATION:
,01 Z2? �IV06111,17Y �Wfe e_XWE
dd ress. 1667,
gks'a
a Description: i40,aa e4k 3-. 1—or
it roperty Tax ID #: 32A5Aal- 0OZZ- 040-6 Lot No. /9
Site Plan Name: Block No. 3
roject Name: 9A1
Setbacks FronBack: Lro' Right Side: j'j(�- us Left Side:
lk
�DETAILED DESCRIPTION OF WORK:
T, C ONSTRUCTION INFORMATION:
A. it onal work to be nertormed undert is permit — check all apply:
I [E] HVAC Gas Tank E]Gas Piping Shutters ❑ Windows/Doors
Plumbing Sprinklers Generator
Electric Q Roof Roof pitch
otal Sq. Ft of Construction: Sq. Ft. of First Floor:
Iost of Construction: $ coo. 0 0 Utilities: []Sewer E]Septic Building Height:
F
,OWNER/LESSEE:
CONTRACTOR:
W
� (Nam ,�A 0/6 9WILOWIZZib�rffe:
d,4 IIIf
�ddress: 6-74A17'
Company:
k. -4,461-C Cad&.
I city: de4�/I/T zlm State: Q
Zip Code: Fax:--
hone No. //- -gAl—
Address:
City:
Zip Code: 5iw5
Phone No. 772 �-
E-Mail:.
State:./—z-
Fax: 77Z495-7065
�Z-bA67
Caw
E-Mail: a_GRlla;X7 qmwz' 40W
Iill in fee simple Title Holder on next page ( if different
I
Irom the Owner listed above)
State or County License:
C(5c 013 _06�e
I! value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ev-
I[SUPRLEIVIENTAL CONSTftUCTION;LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name: //L W�GG�[, �I�/G•
Address: /9A44 B/G7iL10 ST .//
City: State:
Zip: Phone 772-- U 9
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: ,SAAM L1S 4019A
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: IVIA
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: 11/14
Address:
City:
Zip: Phone:
)WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit.
t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
rhich is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
tructure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
i consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
t accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
he following building permit applications are exempt from undergoing a full concurrency review: room additions,
ccessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
VARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
nprovements to your7on
erty. A Notice of Commencement must be recorded and posted on the jobsite
efor t first inspe f y int d toobtain financing, consult with lender or an attorney before
om enc ng work oring y r VlWice of Commencement.
— Q"\ ),A _�_o \ L, �� — UW4%0
Signature o Ow er/ Lessee/Contractor as Akent for Owner Signature of C ntractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �% LuC,&E COUNTY OF .sT, Z&J51
The foMing instrum nt was acknowledged before me
this Al;yfday of 2 by
Name of person
Personally Known
Type of Identificat rn,�-Produced
Notary Public - State of 1`10HON
mmission # GG 010740
My Comm. Expires„Nov 7, 2020
(Sibruffure of Notary Public- State of Florida )
Commission No. �%ham' (Seal)
The for ing instrum nt was acknowledged before me
this day of 20f by
1%O[/lL.4f wilw
Name of person making statement
Personally Known k OR Produced Identi icatioLL
Type of Identification ROGER,
A. PRIEST
,��tip0.Y PpB p��
Produced ry Public =`State of Florida
' Commission # GG 010740
Ml6fij lm• Expires NOV7, AM
,r .BoMo*MMMolrlryAtsr
of Notary Pu . r :: o a
Commission No. (Seal)
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DATE
RECEIVED
4
DATE
COMPLETED
8/2/17 4 4 / . e