HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: /O 127177 SCANNED Permit Number:
BY
St. Lucie County
• Building Permit Application
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
ENT
Address:
Legal Description: l 0 �� i ;5-1Oc./L 7.. t"dvgi_ I [ oUe- /3-eac/,
PropertyTaxlD#: 70/- 0176 - ODo- L/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION;
Additional work to e errormea under tispermit—check all apply: e
OHVAC Gas Tank Gas Piping _ShuttersWindows/Doors "Ac-
11 Electric 0 Plumbing Sprinklers Generator E Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _,? q xy DO
S Ft. of First Floor: _
Utilities:Sewer El Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name NOVEL TkacL malo>c LLC.
Name: TA C"Onesoki
Address: o2a UOINS i I V-er SGy,d s G4-
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Company: '7/o o»np. ah r zt-7-,od, �ih y 41'A'rr�
City: VP-✓O 1¢aGL F L State: FL
Zip Code: 32c) s Fax: "
Phone No. ?I S _, 4.0 - 5-71 y -
Address: PQ. Za k 423b
City: VP4 o 'Btfac+C State: �'L
Zip Code: 3L9G/ fax: -77257/4_q760-
Phone No. 772 5Gy-p001?
E-Mail:3i�vayo.l� s+-�( aAa,-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-mail:IMPAel& CDAcmoscu,s reMY/ot,e�c. Ll oar
State or County License: C-4 e, /5 / t) 95 L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _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 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 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
commencing work or recording vour Notice of Commencement.
Signatgyof Owner/ Lessee/Cont actor as Agent for dwner
SIghAture of C ractor/License Holder
STATE OF FLORI
COUNTY OF_ /7/�I s�tpl C
STATE OF FLORIDA
COUNTY OF Zy al, c. I� LJr
The forgoing instru n w s acknowledged before me
The forgoing instrument was acknowledged before me
this Id dayaf ?Der 20j7 by
this ,&dayOf QCJV,xi 20(l by
fohnT-narcw la - /YlanaAma /l�iirr
• IL,- A —140 Wrm
Na of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known 1/ OR Produced Identification
,Type of Identification
Type of Identification
e
Produced
E Akdeya
AmAura
t NOTARY PUBLIC
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(SignatureotaryPublic-S Z �
(Sign(Sign urPlic-State of Florid
ppy�res 72H912019
Commission No. 9 (>gar!
Commission No. �,r_Re VINA MIC
�� BARKLEY
Commission # FF 080191
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'a , lxpires February 3, 2018
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Rev. 8/2/17