HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:— SCA WI umber:/ 9 (2,<- -7
BY
St Lucie County RECEIVED
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT IJdCATKJN;
Address:
MAY 17 2017
Legal Description; 4,f/ 19 <V.,- g2,9� C, IqC-40111
Property Tax ID #: e)f -5'1',2 — '2 0/ C'm o Lot No.
Site Plan Name: Block No.
Project Name: Lo"I I-Z-1-7 1004�
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 7
36 +-:3 C-
1JHVAC U Gas Tank OGas Piping
11 Electric 0 Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ / 6"940
Z
Shutters E]Windows/Doors
Generator D Roof = Roof pitch
S Ft of First Floor:
Utillties"n SewerElSeptic Building Height:
11 OWNER/LEStEE.'_
CONTRACTOR:
Name V1 4- 4,spl- e a91V 990)
Name:
Address: 11,vc�D c� j0x�
Company: �77#Q
City: -State:
Zip Code: 2 !;t!7 i6 ? Fax:
Phone No. :2 Veoc:P;��
Address:pp,
zlo-re- State:
Zip Code: 947 V-"- Fax:
PhoneNo. 22��-
ftN,7vf,:P"
a . rgR
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: 5 rtR L., c- y—&,, t:z- ceo tv 2F_��Jvz dto/v)
'
State or County License: -"1,033
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
PPLEMENTALjC0N5TRucri0N LIEN LAWANOOMA&ION:
,, , ''j- 1. 1 , , �,,. , ,� ., �'7
DESIGNER/ENGINEER: Not Applicable
Name: zENC-AICZ OU-0-tv8_5
MORTGAGE COMPANY: Not Applicable
Name:
Address:/.to tv. i-,co #w
Address:
city: /_ W te, rz- W.0 R_ 7W State:
Zip:,53soe-&e-_, Phone:.Srgr-59?5-�56,74
—
Cityr: —_ I -State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: --Wot Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: _ Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
no
:ethe ermit holder to build the subject structure
or ang covenants that may restrict or prohibit such
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
K S
SloatuT5Aner/Les1ledXontractor as Agent for Owner Signature of Contractaii/Cicense Holder
STATE OF FLORIDA STATE OF FLOR
COUNTYOF Sl L(Ar,;.P, COUNTYCIF
The f oing Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of I?lQq 20 t7by this 'fay Of e±K),- 20,1
_/ �rlc _�_ by
1Vr17'�d:i1VV P0IQJFh_-.4rV-R4:AAeT_J 0?018A9FA--r ::5;7_AqK
(Name of person ackifowledging) qr�, (Name of person acknowledging)
A -
V)
t
,Z- C
(Signature of Notary Public- State of/Florida (Signature of NotayPubQrWe of Florida)
Personally Known t_-� OR Produced Identification- Personally Known OR Produced Identification
Type of Identification Produced— Type of ldent*iflcation�Producedr-t--'0-13362
Commission No. FIE0 ission No.C-70 61)30z) (Seal)
141t,l)(PUblICS' oofFI nd.
t-t f t
Rhonda C Bie. feldt
gp. Ie;:1d
LO . UIS I EB . RZOZOWSKI 51704
,n Fr 09 1— 1 0 ON ffG
es 0311512018�� WIRES: FB 15. 2021
Revised 07/1512014 , .,1 1 . Bonded through let State Insurance
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