HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll
BE C04.,�_!TED FORtffiffiATION TO BE ACCEPTE_�
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Date: As t 4t5 Permit Number: I - Q 2�Q I
03NNVOS RECEIVED
JUL �2Z_ 2015
Building Permit Aloiplication
Planning and Development Services SCANNED PERMrrr1NG
Building and Code Regulation Division BY St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 St-.Lycie ..
Phone; (772) 462-1553 Fax: (772) 462-1578 Commercial 001nty RISidential
PERMIT APPLICATION FOR:
Address: i
Legal Description:
A164i 41, tj 2,3 4L�CG -4 / _rsc- W !tLV5V ti
W, 7-00 49:7 0'VIL- ro 0
PropertyTax ID #: 45-12, ':3�3 — o0ol — cbcp. Lot No.
Site Plan Name:
Project Name:
14V
Setbacks Front Back: Right Side: Left Side:
—Mechanical
-4 Electric
GasTank
— Plumbing
Total Sq. Ft of Construction: 7724
Cost of Construction: $
- - .1 -- - - - * "6-:PF
— Gas Piping
— Sprinklers
;;..I, , I , ,
(�� —Shutters
81'et'
AUA Ylf W Q i-,� a rnt,
Sq. Ft. of First Floor:
Block No.
�uil ing Height:
'7zv
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�ame: 110 P09
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city. State: _B_
Zip Code::3_1 �_J_ Fax:
Phone No.
Address:
City: 57,446tr
Zip Code: '1461 <"I
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Phofie No- �71'7'
— State:J�_<_
Fax:
E-Mail:
Fill in fee simple Title Holder on next page (.if dlffe�ent
from the Owner listed above)
E-Mail C-946:4e
State or County License_qC
If value of construction is 2500 or more, a RECORDED Notice at Commencement is requirea.
LUI, P, R 0 E W1 E N I MA RG 0 IN 54 NUNN= INF-ORMTHO
DESIGNER/ENGINEE Not Applicable
Joglg'04 Ne%004d-4
MORTGAGE COMPANY: :ff Noi'Applicable
Name: —
Name:
Address:-,w 'r__ /)_WR011JV IhIck,
-Address-
City: S1UfM4_ State: JP� ..,City::,
Statd:
Zip:,%1,,*Q4 Phone::J�J
_�ot
Zip: Phone:
—BONDING
FEE SIMPLE TITLEHOLDER: Applicable—
COMPANY: _g_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 ma estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions y4ichmayapply.
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In consideration of the grantin g 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
commencing work or recording your Notice of Commencement.
(rsc- 0-� in, ----
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Signature of Owner/ Legsee/Agent
-Signature of Contractor/License Holder
STATE OF FLORIDA
Aga
STATE OF FLORIDA
COUNTYOF o
COUNTY OF
The forgoing instrume t was acknowledged before me
The forgoing instrument was acknowledged before me
thi5711 dayof If-CU.1 20J$ by
this,1.2)_ day of J9,L_1 20 -by
CARIS CHAUSS
uclic - State of Fi
',mres Dec 102r0lli
VROA P Ad KK 0 #Usti
(Name of person ackn '.0111111ission # EE 223546
(Name of person acknowledging
Bonded Througb National Notary Assn']
(Vvi,,77� - - M_ - _ - - -
041w, ukito
(Signature of Notary Public;-Stalte of Florida -
(Signature of Notary Public- State of Florida
CA I S CHAUSS
Personally Known Mced Iderk icati ,I Raft a
Personally n ftill!�'? Pal LFM
Type 6f Identificatio Dec 3.2016
74
ype of ld ti ic t on c - State of Fiorida
NotaryPubli
Produced— 223546
roduced fes Dec 3, ]2016
Expi
I JL Notary Assn
Commission # EE 223546
Commission No. I
ommissio 0. Bonded ThiSp#ldonal.Notaty Assn.
ar
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED.-
Kev. 7/2014
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