HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED 1��,
L179 BY
Ki 4 R.1 'Who's M a P6 0 Gas
z - St Lucie County RECEVE
Planning and Development Services Building Permit Application JUL;.2 a - 2015
Building and Code Regulation Division
2300 VirginioAvenue, FortPierce FL 34982 PERWTTIfyL.,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential — St Lucie County� FL
PERMIT APPLICATION FOR: To Select from dropbox click arrow at the end of line
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Address: 642�'
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-Port Pierce
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Legal Description:
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Property Tax I D #: 13 0 3 - .2J K - 000 1 — -7 Lot No.
Site Plan Name: Block No.
Project Name: �)erf z.� 0-7 - C r��,, 67eA 'S
Setbacks Front Back: _ Right Side: Left Side:
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HVA — Gas Tank E]Gas Piping
Electric El Plumbing OSprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 10,00o
S . butters E]Windows/Doors
Generator E]Roof
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�Sq.Ft. of First Floor:
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utilities: [-]Sewer OSeptic Building Height:
"OWN ER/IESSEE:
CONTRA R.
Name—vtyfya- Vjiygle5s pffoliql (00NN%n(f.iJ"VU LP
Name:
Address: -71-7 yet"�o M � 4t boo
CompanyiQ'
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City: 60M R,-�� State: _�L
Zip Code: 3343t Fax:
Phone No. -, C I - 9 9 - K, -7 Q -S
Adclress.�� 97)2�� \Mb
City: (�) — State�-�
Zip Cocle-�A)\\%r� Fax:'�U-W.IAAO �Ib
Phone No.-,hl- �j
E-Mail:—NoA. GqescL- a ov�,
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Fill.in fee simple Title.Holder on rrext page if different
frord�&Owndr] ?.
ifted above)
E-MaiK)WX uL f\Q om
State or County License:z,\:�t-z\&\\.k\\,4,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION,LIEN
7. 1 7
1AW IN F"ORMATION: -
DESIGN ER/ENGINEER:
Name: �Vaoqo,;,4 P, hil foe erA, di�
Not Applicable
fp4ilpiven� LL C
MORTGAGE COMPANY: Not Applicable
Name:
Address: �318 A I
0 -mn� IA'P'
Ae
P�-J
Address:
-21
City: -3 " r
Zip: '33qs'% Phone: (611 )
State; Fi-
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City: —State:
Zip: Phone -
FEE SIMPLE TITLE HOLDER:
Name: S � C4 ki.5 4 S�V,le;,t
Not Ap licable
PL
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BONDING COMPANY: Not Applicable
Name:
Address: U6 I -7ydV/'6 , 94
Address:
City: _Ii7c, Piect
City:
Zip: -1615 Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conl7lict 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, 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
of Owner/ Lessee/Agent
Signature
STATE OF FLORIDA STATE OF FLWIDA -
COUNTYOF M�,M GEEA-r-1;4 COUNTY OF N't \()T-�
The forgoing instruDent was acknowledged before me The forgoing instrument was acknowledged before me
this _[�'gday of —'6 %3 L� 20 L�Iby this2a day of 20 \�)_ by
(Name of person acknowledging I (NaX if person acknowledging) 5
of NotgN Pu44- State of Florida )
P 13mrigirpri IrignLigr2fin� -
Personally Kn n ( 0yuced �Id Personally �novm K
a t ow Type of Identification Prod
Type of Id( n ification P KEIIY7lqA -
y 0:
Apt 2018 f, MY COMMISSION# EEBM9
IT 19 B.'dD 4pm 13
F 1 8 Commission N�
Commission No. In 0 F 0962 brd2117
nderwritam
Revised 07/15/2014
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