HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE J
Date: '>���� SCANNED Permit Number: ��b�J' 03-1
- BY. RECEIVED
St. Lycie County
Building Pe snit Application MAR 15 ,
Planning and Development Services ST._Lu_c_ie County, Permitting
Building and Code Regulation Division ------ -
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
,PROPOSED`IMPROVEMENT
LOCATION -, ';' ' °" Y
Address: `b N 10 on '
alrn
Legal Description: C�nt�0.mo(i Y��1Ac Ttwf b a U2 /� (21&Y - r Lc, ' 3 1),,41 1
q
Property Tax ID \,9b a, - Q17a.lD - O b e= ^ 3 Lot No.
Site Plan Name: Block No.
Project Name: W,—&—iLea S Ch we a,`t-2
Setbacks Front Back:. Right Side: Left Side:
DETAILED DESCRIPTIONOF WORK .
-e �AiGP �c1 sc� Dn SQPe2o--�e
-�h rov M alOdce J�f� - k,�e e
CONSTRUCTION INFORMATION::
rtiona wor to e e orme under tispermit—checka apply:
11HVAC MGasTank []Gas Piping ❑Windows/Doors
_Shutters
® Electric Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction::, SFt of First Floor:
Cost of construction: $ O 0 Utilities. Sewer Septic Building Height:
>OWNER/LESSEE: ,,' .
CONTRACTOR _•.,
Name 7kCh6k(A `JCS 1v.1'r+r,n1PF�
Name: '-i- 47 -o
Address: \aK a.� Ntiil `\(�4ln11�71 A'\?2ti
Company: GTLKCn 00nS� Cl t C dYt Tn(I
City:iqLh State:
Address:tbll 0! _
-
City: J�M-,,Elti State-
Zip Code: 131Jc;Xc1D Fax:
--EL-Phone No.
Zip Code: Ri5 % Fax:
E-Mail:
Phone No. 77a_-334-9) 1 9
Fill in fee simple Title Holder on next page (if different
E-Mail::SPrV;016a)-GAVA(n PGytSiY c.-H 8nl viC,.C-dl1k1
State or County License: LG I Ala 1 SZ I
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
$UPPLEIVIENTALGONSTRUCTION L1EN•LAVU INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
Zip: Phone:
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 andcovenantsthat 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 intend to obtain financing, consult with lender or an attorney before
as Agent for Owner Signature of ContraT ct r// icense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF MOB ; fl COUNTY OF i n
The f�oing inst mentwas acknowledged before me
this day of�� . 20 aby
V 1'nE4,"ra nct7
(Name of person acknowledging)
Q�.0P,
(Signature of Notary Publ - State of Florida )
Personally Know
Type of Identification rp�t(1AW DANIELLEZIELINSKI
Commission#FF926792
Commission No. g' W Expires C(SftJ 13, 2019
U,M Ttr T, FM Nceare 9003957019
Revised 07/15/2014
The forgoing instruum,'entwas acknowledged before me
this V5 day of Vic-n 20 nby
\I,e (c i / 4 -G a.ncc0i
(Name of person acknowledging)
�f o�e z -
(Signature of Notary Pu lic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Prpdwsad�� ...•.2.,._.,.T ____�._ _
Commission No L (Seal}` 926792
:>,13, 2019
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