HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE _e' FOR`APPLICATION TO BE ACCEPTED -
Date: (9' /QU110,781�f1er it Number:
03NtiH,)c RECEIVED
1401
Building Permit Ap Ii1+irSIAC11}CfI n JAN 19 2016
Planning and Development Services �vn'tl„��S PEP,rr11TTING
Building and Code Regulation Division BY St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie COurb
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Address:
Legal Description:
Property Tat: ID#: '�y�5"V11OOX—lp—Q30y—acc>—z:7Z, Lot No.
Site Plan Name: Block No.
Project Name: �fL7�o C t�Di\ S�G1a OPJ
Setbacks Front Back: Right Side: Left Side:
7M hanical ZPlumbing
Tank Gas Piping _Shutters
Electric _Sprinklers _ Generator
Total Sq. Ft of Construction: ;dq S> F. Sq. Ft. of First Floor:
cost gfSQri trdetWni$ U ilit'es: Sewer Septic
'C41 dog.
III,
Windows/Doors
Roof
Building Height:
OWNE /LESSEE:
CONTRACTOR:
Mamet ji�i�z
Name r uCo
•P�r'
Andre s "QNJ<S'- VS Kati
Compalny_' Csir
Addresns:-+ 3� /J.IA/ (O j
"%(:Pi✓y%-
City. Vr i3O �'`> Stated �
•Zip Code:��.Aq Fax0YIA\c:k'14r
Phone No. (:,, 5%75*-55 3
City: '(,8 + I <r2 124N6
Zip Code: 0:�j
Phone No
s State:��
Fax:
02 D
E-Mail:
Fill in fee simple Title Holder on next page ( if different-
from the Owner listed above)
E-Mail j ti ef,Y lee,a,
Qh1Gt 1 G di4'1 '
State or County License
CG ! 99.6 Zz6 r'1
If value of const,'u"clion is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name: _06—, /euJ�a.
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:_ 2�a i7 S� //°rn��
Address:
City: 0ori.S t 1,,�
Zip: 752 Phone '77�
State: �L
- !i7f- 33 9-o
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
SUPPL MENTALCONST - .ION LIEN LAW INFO MATIQN:
OWNER/ CONTRACTOR AF.FIDVIT: 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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conIct with any applicable Home Owners. Associatioh 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, cons u with lender an attorney before
commencingwork or recordingour Notice of Commencement.
Rev.
Signa�Eare-°o`f�Owner/ Le' ss`ee/ggeri�
Signature f Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Si -
COUNTY OF�fduiQi' J
The forgoing instrument was acknowledged before me
The forgoing instru%kent was acknowledged before me
this�Klayof �rC[-'rneE7C .20/J�by
thisr�dayof I IDU2� .20�$ by
_✓YIA�rxFra Lvr� l�uv,,,,,,6
HA11AC-L ('tlIL
(Name of person acknowledging)
(Name of person acknowledging )
t
(Signature of Not Pub is -State of Florida)
(Signature of Notary Public -State of Flo`;cje��)aVyETTq
Personally Known OR Produced Identification
Personally Known �OR Produc�dldentifieation
Type of Identific
Type of Identification
Produced � o••"vo"'•. DOROTHYANNBA]20)
Produced = '"'°'"'20's -
:' Na EE 707lf2 ;
Notary ubl`ic -State a
--
Commission No. My Comm. Ekpdq�Oct
CommissionNo���:eal)��c;ommissiddn'n0��ti�••-
BonAed ThroughNational N
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REVIEWS
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VEGETATION
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