HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: _(010119
7 BY
.d Uik - t St- Lucie County RECENED
9� Building Permit Application
Planning and Development Services OCT 12 2017
Building and Code Regulation Division PFRMIT
,TING
2300 Virginia Avenue, FortPierce FL 34982 St. ucie untli,, FL
Phone: (772) 462-1553 Fax: (772) 4152-1578 Commercial Residentid VC16
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
1-'OkbO(i�sffb'imORO-V.EM�NT,'LdCA-T[6r�:-
Address: 14 00 �) . Uekan -1)r. 70 LJ
Legal Description: San&-bollm Clas Conclomon'im E — unl 704
Property Tax ID #: 606 - 00,17 - wo -7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
f
-r6 J)
UCTION. INFORMATION
AUClitlonalworl(tobenertormed under this permit- cneCK all apply,
[:1HVAC Gas Tank DGas Piping Mutters X Windows/Doors
DElectric Plumbing OSprinklers El Generator D Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ C:9
S Ft of First Floor:
UtilitiesIn Sewer El Septic
Building Height:
r.cONTRACT
R.
Name— Rnd
Name:
Address: 100 1 01 -ATA"
RA
—A
Company:69//-'4e_/_7-v//
City: 0cL1KP_e-.;Ae State: M2
ZipCode: ai-iq3-q*3'A'1Fax:
Phone No. (30), 1? qs% 9 8 6 1,
Adclressz,4�5_ /0&7'V 725_-� I-10Z7;-1
City: 'rZ,9,41 State:
Zip Code:S3 L118 Fax:
Phone No. i�Tia_ Jr - _1911--/Wo
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License: e46d 65-C73 :5'-/
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.�SLIOPLIEMEN'TAL t6N'S'TR'0'CTI0N LIEN LA)k_lN_F0JRM '-'' N'.
AT10
DESIGNERANGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
State: _
City:
Zip: _ Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
—Not Applicable
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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in con4ict with any applicable Home Owners Association rules, bylaws or an9covenants 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
commencinia worl4iTe—c—or—dihe vour Notice of Commencement.
as
STATE OF FLORIDA
COUNTYOF
STATE OF FLORIDA
COUNTYOF
The foRqlwnstrument�gwak,,acknowledged before me The forgoi . Fly ristrument was acknowledged before me
this' --I dayof 17V 2 0 _/-7y this 6- 'day of 20 / by
_7
k ucppy-6 Lw�fto � Uchaal Ckkax ltpn
(Name of person acknowledging ) (Name of person acknowledging)
(Signature of Notary Public- State of Florida
Personally Known \/_ OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
(A AyLeA9h,—
(Signature of Notary Public- State of Florida
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
# GG 056886
'T1's MYCOMMISSION MY COMMISSION # GG 056886
Revised 07/15/2014 EXPIRES: December 28,2020 A0 EXPIRES: December 28 2020
',ZWp�" 13"itled Tbw Notary Pubk Und"wdars '.-P �"A
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