HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CO ETED.FOR APPLICATION TO BE ACCEPTI
Date: 7)4 SCANNED Permit Number: —Z
BY
St. Lucie COUnt\/
RECEIVED
Building Permit Application
Planning and Development Services JUN / 6 2016
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: 1a1ql9&o - 1� 14 �.Q_ Ha(batC'K BLU - U8 h
Legal Description: Arssec,*,-i-ro/u, Z,.c
Property Tax ID #:
um — CCU
ULv - L%_-o
r_va -b
r
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front
Back: Right Side:
LeftSide:
!7"*
Ze e 1 0-61 ^j ,,t.�"e oloor-s Lilee -For
ATIC Nj—�4
NS C-. 17.1 9Nb I NF 9 RIM
Aaditional work to be nerformed underthispermit -check all thaiappiy:
_1464ndews/Doors
0HVAC 11G I asTank as PipingShutters FX
11 Electric 11 Plumbing R51prinklers 1:1 Generator ❑ Roof
Total Sq. Ft of Construction: S'C Ft of First Floor:
Cost of Construction: $ _�2000 - 00 . Utilities* Sewer OSeptic Building Height:
'OWN E A'/ t 8 t t E
Name 'SaOT45'.,, "L`" 0-100 4"r -
me- -�JOn;--Loi9e'z
Address:_1-_(Ca00
l� dl 4e r, aae por-5
City: liar -k- ST-' LV)cr-*- Statd,"
Zip Code: 3995'0 Fax: 35� -
Phone No. - :27a- 973 -60'q
�kdidir-egi�'il- fal'j`fs A. miaW ""Ave
State.--F—/-
Zip Code: 3V963 Fax: 41A
-Phone No. 78) 200
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
,
E-Mail: _,,90(0Qr)adX C& y"Op . COP,
State or County License:
it value at construction is 52590 or more, a RECORDED Notice of Commencement is required.
SIIJPPLEMENTALCONSTRY
IU LIEN L4W INFORiVIA'1101�
DESIGNERANGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
ZIP: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_y/ Not Applicable
BONDING COMPANY:
Applicable
Name:
Name:
_Not
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 permitapplications ar'e 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
comrVericift work or recording vour Notice of Commencement.
Lam/ /�
_ Signatur of Owner/ Lessee/Agent
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF S� w(xi E COUNTYOF �ti'LC1ihIF�
The for ��((,ng instrument was acknowledged before me
this RITay of YI ILI - 20 �by
Cj
hanlltsu�
(Name of person acknowledging)
The f rgoing instrument was acknowledged before me
this day of Ij 20 J(4L by
\AnA \i 5 i mfilf�7
(Name3f person acknowledging)
(signature. of Notary Public- State o&orida ) (Signature of Notary Public- State of Florida )
Personally Known OR ProdySed I entification _2�_ Personally Known OR Produc d Identification
Type of Identification Produced P L L_ Type of identification Produced fd 0.1
Commission No. Nip ''���'' �TMM �TQ�! �is ,n;N¢: Seal.'`
WCOWASSION FP942SY4' (Seal)
)
'rl"I i 24, 2020 — -
Commissi6n,#'F0•-115637
Revised. 07/15/2014.< My Commission Expires
R,,'O Juna 19 9niA
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