HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IV ID 0. SU6 Permit Number:
SCANNED
BY
St. Lucie County
Building Permit Application. AUG 21 2017
Planning and Development Services PERilin'TING
Building and Code Regulation Division St. Lucie Count,'. FL
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
Address: -5C10) 5 US k4WY
Legal Description:/O 3Go LkOS 1-50 ff bf- SE '/ynF5G 9'LIOF NW '/4-LE55 ()53.
Jk2D A TQIA,�LE '�A X- Ap-T (w N u Me Rs a4. FT- aY yss 1165 DESL
Property Tax ID #: _ 3 y I O ^ ci yy - C)tbb Lot No.
Site Plan Name: Block No.
Project Name: S_) 02AP�C -DGPOT C( &STE'- L%.-L
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�asTPd-� Z;NTeeiLc>a STai?AC C- COWL IA1f�frV1L� 1 S 1 f��� LI GI�TI� �
CONSTRUCTION INFORMATION:
itiona wor to a er orme under this permit -check all apply:
11HVAC Gas Tank ❑Gas Piping In Shutters ❑ Windows/Doors
Electric O Plumbing Sprinklers E Generator ElRoof Roof pitch
Total Sq. Ft of Construction: / 1, 8Q16 S Ft. of First Floor:
Cost of Construction: $ e-Z5 o Utilities: Sewer Septic Building Height:
OWNE LESSEE:
CONTRACTOR:
Name OCh V na
Name: (DPE0 1� tr�IJ s
Address: 1110 C
Company: S v\LC
LLL
City: Y C J State: L
Zip Code: - `IHLt5 Fax:
Phone No. 771 O-V 8 731
ntl
Address: y Ntpn
c.- Wk
City:7T�,R.t 5TLXJG—'
Zip Code:2(Rbb 0 Fax:
Phone No.SciCoI 3?- 4CY 4
State:-Jff�
E-Mail: ",0e 06i JA l Mu:1. LBA^
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: ha r•tJ-b`l:S 1 (C- Soria,
L- • Covti
State or County License: C 11C. 121,59
4 Lq
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIG
Name:
R/ENGINEER:
L W-LIQ44I
Not Applicable
11ie,
MORTGAGE COMPANY: Not Applicable
Name:
Address:
k4iS�
ELT ts?E #�y
Address:
City: V,L_
Zip: 4C.�
LI_ Phone 77a
State: L
-7 6-RiS 1e
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name
% Not Applicable
BONDING COMPANY: �d Not Applicable
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 apermit.
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 ur pr rty. A Notice of Commencement must be recorded and posted on the jobsite
before the fir r pe ' . If you intend to obtain financing, consult with lender or an attorney before
Owner
STATE OF FLORIDA I STATE OF FLOR DA
COUNTY OF Li1Ca.L COUNTY OF 7)
The forgoing instrument was acknowledged before me
thisIL day ofAm&S s,+ ,2012by
Name of person making statement.
Personally Known ( OR Produced Identification
Type of Identification
ProduceclLlLvt e_ eb-•I l n
-(Signatbre of Notary Public-
Commission NoFlr-°1715339
REVIEWS FRONT 2
COUNTERF
DATE
RECEIVED
DATE
COMPLETED
Rev.B/2/17
The for oIng instrument was acknowledged before me
this day of J 2012 by
ire-& t3. Cgro-44k5
Name of person making statement
Personally Known X OR Produced identification
Type c Identifi t1/
Produced���G,
V�
(Sign ture of Notary Public- S 'ria I
APRIL R. NELSON
APRIL R. NELS m ssion r V 533 °t�Ztn MIfaBRLI�IISSION #FF975339
My COMMISSION# 975339 j-,r EXPIRES: MAR 24,2020
EXPIRES: MAR 24, 2020 'qnm?, Onto I$t Stile ImY10 u
IonAed through is Sta""'ran"
S VEGETATION SEATURTLE MANGROVE
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