HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIIIAPPLICABLE INFOUIJU BIECOMPLETED FbIt'APPLICATION TO]3E ACCEPTED
Date: \96 Permit Number:
SCANNED BY
St Lucie Count DEC
Building Permit Applicatio
Planning and PevelaqmOnt Services ST Luce
861/dIng, and Code Regulation Division
2300 Virginia Avenue, ForrPlerce h -44992
Phone: (772)461vIS3 Fax.--(17,!f462-1578 Commercial Residential
ECEIVED
2 0 2018
County, PefrnItting
"PtRM1TAP;PUcATibN FOR:
Address- fa&f.NUjSVJF-F(-
Legal Description.- 1N rp=
PropertyTaxlDr.#:
Lof No.
Site!Plan Name-
Block No.
Project Narne:
Setbacks FrorttBack:_ Right Side:, Left Side.:
P.%Mle" 11D .4- 0 Ro 17 .4 A01))f -VAn
Irl tc
"itional work to,be per.formecl Undey,.Ihis-,,permit-,ched(,alithat.apply::
Mechanical Gas Tank. Gas Piping Shutters -Win
Electric ,Plumbing —Sprinklem Generator Roof
'Total Sq. Ftof Construction: 373(nc7 5r- MW Sq. Ft. of First,Floor.
Cost of Construction:,$' Utilities:, Se W. er, _Septic Building
Name M-)Gdt;AJ& AJAW VIKKr Name: fRN.461`50V UjYW
Address: Company: Woz
I ia&rrWa41b" aja -MMIL
City: 961,14 &,t4 State:-jL- Address: :�j4g:/Vu)jZqt�`WAY
Zip Code: 21944 1) Fax:- city: sgkmo
PhoneNo. Y13 M 7W4,C) ZipCode- Fax: q3y
E-Ma 1: -61 2
I -Ana W P-0 C V- C . a !A 6nm caj , VU- Phone No
Fill In fee. simpleTitle Holder diffirext pagef li'different E-Mail
from the,QwnqrI1stqd above) State or County License CCCjiptls,3�
ows/Doors
Pitch
eight:
—State: Pr-
99 q j^6o
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If value of construction K,2509or more, a RECORDED Notice of'Commencernent Is required. qui d.
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FEE.SIMPLETITLEMe r Applicable,
Name:
do
BONDING COMPANY:Y
Name -
f.. ..`
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Phone:
OWNER/ CONTRACTOR AFFIDVIT. App
I certifythat noworkor'installation hascomn
St. Lucie Countt,� makes no.representatton that
which is in conf l with anti.applicable Home t
structure. Please consuit'Uth'your Home Owr
In considerationbf the granting of this request
in accordance with the approved plans, the Fic
The following; building permirepplicationsare
accessory structures; swimming pools, fences,
m
EM
n as indicated.
10
Agent far Owner S" atu of nt
Igna�S—tu�of'OvdngrJles,See/Contractoras • c fftienseHo ec
STATE OF Roam �q SJ /� STATE OF FI:Oq�pA L
COUNTY OF d M j?lr I COUff1 Y OF 5 Y
. The forgoing instWenYwas acknowledged before me. The forgoing instrument was acknowledge before me
this day of. cJpC>_ _ 24 j� -by Yiris loi . P 20 by
�v�eYTe i`�awrcx�tz t co <as�a+�a
Name of person makklhg`,statement. Name: of person making statement -
Personally Known ^ OR Produced Identification Personalty Known OR Produced Id ntification
Type of, dentification Type of Identifi] tion
Produced Produced L � L
((Signature of—Notmary Public t Lr E 11 (' atu e;of Nota to o� EcrvENS
NOTARY PUBLIC ', spz'•'�"'• `'•. MY CpMMis NA GG 022023
Commission No. rI'd I con(g gkyealth of Messachu �& isslon.No E%PIRESD it 2020
My Commission Expires April 27, Gr9 �.• B„aeanvuNon uneenvdlers
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