HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-All APPLICABLE NFO UST B( MPLETED FOR APPLICATION TO BE AC41 ED
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Date: 2 / Y ,�Cp �� Permit Number: --��3�
566;
3 SCANNED
BY
�rmit Application St.LucieCounty
Planning and Developmentjaunty, FL 7 /
ion Dices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 MAY 2 6 2015
Phone. (772) 462-1553 Fax: (772) 462-1578 COmmlercial Residential
PERMIT APPLICATION FOR: ate Coung5 FL,
,
Address: 12-(o QUeeA) VH1rLS'i-IRl ft C4,,,4
Legal Description: i. o� Ci q sua — Q uG'e1lLS Cove -
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Property Tax ID #: i V / 4— -70 — Co 7 r- (AGO-2- Lot No.C
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Site Plan Name: Met- rterrLs ke C tc••ZAl(.No— Block No. _
Project Name: T•eAdeenC- 30�e-e.N c�o8os"�
Setbacks Front Back: Right Side: Left Side:
Ek;c,kobjtj!�rc. koUtN-1A 647N200111 A ddl,tiel
W k
Additional wor to be pertormed under tis permit -c ec all tat apply:
Gas Tank _Gas Piping _Shutters ✓Windows/Doors
_Mechanical _
_ Electric ✓ Plumbing_ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: - 3M `4. Sq. Ft. of First Floor:
y�
Cost of Construction: $ `t`, S00 • Utilities: _Sewer ✓Septic Building Height: I 5 ov'
t xn
MINIMUM
Name: 9—t -To
Name M c�% �N �s
Adde ress: Zoo QueN5 lLlC1rIS_i1vA
Company: ZF}19 t7-05#7 to r✓
City: l'e.Y-C.'e �,:_. State:_
Address;. 37`l iO Y^Ve j—'•
r, >a:. .
City: • Vero l3 eRG1rf State: PL
Zip Code: 3 C Fax:
Phone No. f Jzq-39 1�O.
Zip Code. 3 Z9C Z ' - Fax;:^ r
Phone No. `772--6_ZP- 1760
E-Mail:PIVItIS
Nei-
Fill in fee simple Title Holder on next page (if different
E-Mail: %Atg tT-o5KV e C'OAJ"ST. NET
State or County License: G /S /(o 7- /3
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not
Name: Nbi— L. DInSOV
Address: C,0 10 1 s r S y-e_r V Svi 102—
City: \ -P r'o Q_1gC, State: C,
Zip: 37, & 7 Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: A I
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: U.SAA
Address: I elorp lift SvLW,
City: rid State
Zip: ti,� Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 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, sighs, 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
commencing work or recording vour Notice of Commencement.
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Signal ire of Owner/ Agen ssee
Signature of Contract icense r
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF L
COUNTY OFF Ate,
The for 9tng instrpment was acknowledged b fore me
this � of 20�y
The forPPo�ing inst,t,,,yyyriA{{{n���-ent was acknowledged before me
!O
ay
this day of 20� by
(N Tf person acknowledg' ).�
( ame(pf person acknowle g)
(Signature of Notary Public-S of Florida )
(Signature of Notary lic- State of Florida)
Personally Know' OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. (Seal)
Commission No. (Seal)
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