HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED F(R&I@MVM ACCEPTED q /�
Date: ZO • 23, / 7• SCANNED OCT 2 7 2017 Permit Number: �� 0. 0 (p I V
tS- L BY PERWTTING RECz:i- r ,•..-.
• St. Lucie Gount�t. Lucie County, FL t''� '
- - Building Permit Application OCT 27 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial f Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: WG,A3 Rc nLY r 2;rJle R l VJ
Legal Description: 140f- n r lZ d5,e Acd C Jfcld
Property Tax ID #: ^'MQ r'^^z-'- Cpol - 000- S Lot No.
Site Plan Name:
Project Name: Acri-,.,n Rid9, r4,1 ep
Setbacks Front Back: Right Side: Left Side:
R-eploce a Rp }�
Gas Tank
Electric
Ch: )) ers — -exaCi
Total Sq. Ft of Construction:
Cost of Construction: $ ) a O C>Q
Block No.
Shutters ❑Windows/Doors
Generator Roof Roof pitch
5 Ft. of First Floor:
UtilitieslnSewer ElSeptic
Building Height:
;Q,WNER/,LESSEE
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NAR
Name u^^)�nur Raq-Q
Name:.5• R>sc-CC-f
Address: 9COD 14or)roc R,d� f
company: Ai S-IrJar-
city: Pe') CA State:PL
Zip Code: "3999 O) Fax:
Phone No.
Address: ISS9 SW al )9ve
City: T4 Laud er cla)e State: F'L
Zip Code: 333 0 Fax:'3GG - GICZ- (-'I
Phone No. �7;G) - 0a9 - SS/6
E-Mail:
Fill in fee simple Title Holder on next page Of different
from the Owner listed above)
E-Mail: der, ' ; �m -Qw
State or County License: 10:5--
If value of construction is $izwu or more, a KCLUKUCU NOUCC UT cuummu�cwon .� .ry..••.....
SUPPLE_MENTALCONSTRUCTION'�LIEN LAW INI-UKIVIHIIuty
s
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Nit Applicable
Address: I Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
—
BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to bo me work ano nl5rd11a11U11 as II,UII.CICu-
I certify that no work or installation has commenced prior to the issuance of a permit.
no
build
structure.
uct a rrr Please
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structure. Please consult wnh your Home Owners Association and review your deed for any restrictions wrilcii may apply.
In consideration of the granting of this requested permit, I do hereby agree that 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
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Signature o Owner/ Lessee/Contractor as Agent for Owner
signature of Contractor/License Holder
STATE OF FLOR14A
STATE OF FLORIDA
d
COUNTY OF Si I u
COUNTY OP2ruV-J
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
25 a by
this 23 day of Qc4 20R by
this..4—day of )Q)
�a�e C,UCC,':, s
V ilk Co 4Jer p
Name of person making statement M.
Nanlie of person making statement - z
Personally Known . OR Produced [den 9e
Personally Known OR Produced Identification-
a
Type e of Identification y' a
Type of Identification r;; a
<i
Produced
3
Produced 3 .. -
(Signature of Notary Pub r '., ,,
Si nature of Notary Public- Sta f I i
(g ry
NA91,441.6Er1F16C
Commission No. - ±+^ n..:
-state al Flrn:A
Commission No. N (S'ealastr•G2'asx
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REVIEWS
FRONT
ZONING
SUPERVISOR
.PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I o
6—
Rev.R/2/17