HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLEj1�S(IFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U �' 1 - Permit Number:
SCANNED
-� am-9- y. - BY RECEIVED
• .St. Lucie County.
-�
Building Permit Application AUG 14 2015
Planning and Development Services -
_
Building and Code Regulation Division "``��`"'"'•'� -
2300Virginia Avenue, Fort PielFL34982
Phone: (772) 462-1553 Fax: (772).462-1578 Commercial t� Residential
To Select from dro box; click arrow at the end of line ,�;�,,.�- .-..-�.-�-=
PERMIT APPLICATION FOR: p
.•
ROP�GI5,�D3aPR0Ui- r� L�CA, IOiVa , ,
Address: 9 55—% 5 U S 14,W V
Legal Description: S� I �' e G��c:2v, 5 Ito la CIO 131►c 3 aer l o�< `1.5.�
Ls(G S w o S j NAP D f!s�=
PropertyTaxlD#: Lot No. 4/.,5ito
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
16-S%k . No- W 3 1166 N. 5arv;W cot nt t cJ� ,nC�_
C51a ;U «'10 INFMAMoak a-
me tisper-c ec
wor to n ormunderm
1jHVAC OGas Piping Shutters ❑ Windows/Doors
_y:ona
GasTank
Electric 0 Plumbing ❑Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
w Height:
Cost of Construction: $ LiUOl� � Utilities: _ Sewer Septic Building
OWNER/LESSEE,
MET
Name: Show.- Vizln%c)
-'
Name el r~ 1J eV
Address:
Company: %wME =1%c-- -
City: Stat d!n-
Address: 4ri\ % 4asg�� l awt
State: L
Zip Code: Fax:
City, c% ex- cs-
Phone No. a� '1�)�- �l - f�') Ool
Zip Code: _6r•1Fax: S
E-Mail:
Phone No. 2=1k -Sg52
Fill in fee simple Title Holder on next page (if different
E-Mail: - CAW Mlllll Q C o.ncaSA-. 11
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. .
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not 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.
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, 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
_ Si ner/ Lessee/Agent
S TE OF FLO IIT
COUNTY OF .
The forgoing instrument was acknowledged before me
thisI If day of A1&11� 20 -15-by
s
Sign ontractor/License Holder
STATE OF FLORIDA
COUNTY OF S� L4A/I.CX
The forgoing instrument was acknowledged before me
this 74 day of20 15 by
(Name of person acknowledging) (Name of person acknowledging)
A Yn A d lSat/K-Q
(Sig ature of Notary P,ub/lic-State of for da )
Personally Known OR Produced Identification
Type of Identification ProdU1171
Commission No.
Revised 07/ 1512014
.(Signature of Notary P lic-State f Florida)
Personally Known OB Produced Identification
Tt(e of Identification Pro , ce,
nI ry Punoc - State of FI IQa jmission No.
'domm. Expires May 7, 0
Commission a FF 1207 9
Nblic - Slat of Florida
M
NO
May , 2018
Commission N FF 120, �a
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