HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATIOJN TORE ACCEPTED
Permit Number:
RECEII'zD MAR 072016
SCANNEDBuildin Permit Application
BY
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �af�dF
PROPOSED IMPROVEMENT LOCATION:
Address: 353 VY-j a \/1 tck- BiVd .
Legal Description: \21V e V 1Pbx- - )r11 r A B\ \L �Q L-6t 30
Property Tax ID #: _ 31A \ of - 53 b - c12\u - O O O ` 0 Lot No.
Site Plan Name:
Project Name: 1\6vG nce- Avtn R1r*!> '950-I
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: III
SE p,-"ACyrd Teas o cf e-xitt-,v,� goo 5t s�er�t ,
Oro ('S ��}c,-�e,
CONSTRUCTION INFORMATION:
itiona wor to e e orme under t-checkispermit a apply:
0HVAC LjGasTank []Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: (DSSZ S Ft. of First Floor: C.0552-
Cost of Construction: $ �i$ \iA - Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name_ iNcAyanCe ko n QAY-ES
Name:
Address: -'PO 'bb)L 2-11h
Company: a VA"
the,
city:State: VPk
Zip Code: Z \ 00 \ Fax: —
Phone No. 2-15-gCM-40Z5
Address:!k2i5g �bQ1 EN ( \y\0 V-D&C4
City: cmk-Of*
Zip Code: M\LV
Phone No. a5' - qq-i
State--EA-
Fax:Z15-Qa1-QO2LO
- 0025
E-Mail: --
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:Wr-A W1 OUS
(7 C�Y0.Y\�\Yl LOYYI
State or County License:
it value or construction is $2500 or more, a RECORDED Notice
is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:_ NIK
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Not Applicable
MORTGAGE COMPANY: �X Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
Zip: Phone: I Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Applicable
St. Lucie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in con>'lict 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 witkdenr an attorney before
commencins work or recordine vour Notice of Commencement. /'
s
_ Sigre of wner/ Lessee/ nt
Signature of Contractor/License Holder
STATE OF FWMEIA PA
STATE OF FLEA PPI
COUNTY OF B% )rJe S
COUNTY OF 15 �CV 5
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of F-P YUftfT 20 �by
this day of Fe\WQ0LVLk , 20 _UL by
V�il�Jk�.l( ties,
b -N%0 ZaAlL iW
(Name of p on acknowledging)
(Name of person acknowledging I
e of Nota ublic- State offer)
(Signature try Pub c-State of Florida )
VR
Personally Known _ X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
COMMONWEALTH FPENNSYLyANrA
COMMONWEALTH PENNSYLVANIA
Commission N ALS ea
Commissio o. SEAL (Seal)
SAN N. FPc&OUS, Notary Public
FUNaUw
SUSAN N. FAMOUS, Notary ublic
''
Townshi , Bucks County
na:' omiss on Revised 07Expires March 5, 20 7
%15/2.6I
P y Ct+mmission Expires March
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