HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11. /ilF1. 17 SCANNED Permit Number: 1 I 1 cf�L1
BY RECEwE®
St. Lucie Coon#%
Building Permit Application NOV 2 0 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 x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
cA4O S. • :a •
Property Tax ID #: 4 501- 502- OOLE7 — C100— 5 Lot No.
Site Plan Name: 0Ce0nl:] tJ()r4-h T Block No.
Project Name: Pzf sch Rf%Wdence
Setbacks Front Back: Right Side: Left Side:
Tlemove and repiace. window. (I) Double dung
impQc+ window.
;COkSTf{L)CTION 1NFORI111AT)Oltiw>> ;� �' • t=, `s'
�:'l .- t .w... ..i4
itiona wor to e e orme un ert ispermn—c ec a apply:
11HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors11 '
Electric OPlumbing OSprinklers Generator Roof = Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 16m �Q Utilities: []Sewer D Septic Building Height:
QWl�€E�2%LESSEE wf
ll
.GG)fUTRACTOR
Nam�1101YK1S•t rf0ia 1ZOf'SCh
Name: QLA21
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LQPI'C
Address cict4o 5. neeQn wVe unit4iC
company: —rile G1QS5`PM09reSSi0M1S
City: Ier)sen Beac_i, Staten
Zip Code: 5tigg7 Fax: • N I Pr-
Phone No. '17Z'2Z.9-5531.1-
Address: 35'70SE Mlie_ -+1W)f
City: s*Li Lir+ Stater
zip Code:34997 Fax:286-0459
Phone No. '17Z•-2-b10-0459i
E-Mail:pM=sx+�kW1[JoUC1.coM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:_O1 QS4•p1ms oQepw 02
—e—rMltS
State or County License: (q3 625
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
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MfiR7GAG� COMPANY:
Not Applicable
dE51GNERJENGfNEER: Not Applicable
Name:
_
Name;
Address; _
:Address
�
City: State;_._.._.State
Zip; Phone
Zip;_Phone:
FEE SIMPLE TITLE HOLDER: ,�„•
Not Applicable
BONDING COMPANY:
Not Applicable
Name;
Name:
Address:
Address:
City:..
City
-
zip-. Phone:
Zip;. _ . .........phone:.
OWNER/ CONTRACTOR AFFIOVIT: Application is hereby made to obtaih 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 Count? Makes no representation theit is granting a permit t1ill authorize 'the permit hold%Pto build the subject structure
which is in conflitt with an applicable Home Owners Assacratioh 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 pert' 1t;1 do fie4y agree that) will, in all respeets, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments,
The following building permit applications are exampt from undergoing a full concurrencyreviewi room additions,
accessory sttuctures, swimming pools, fences; walls, signs, ssredn rooms and accessory uses to another non-resldentlal use
WARNING 70 OWNER: Your failure to Record a Notice of tornmericamhnt may'Fesult in your paying twice for
improvements to your property, A Notice of Commencement must be recorded.arld posted on the jobsite
before the first Inspection. If you Intend to obtain financing, Consult with lender or an attorney before
commen •n "k br recordingyour Notice 0 Gomme cement,
Rev.8/2/17
Signs _ pf Owner/ Less@e , ontractor as Agent #or Owner
5lgnatU of Contractor/License Holder -
STA7E OF FLORIDA •
STATE OF FLORIDA
YY10.Y+� n
COUNTY OF YlJi�.r+i rl'
COUNTY OF
The for oing instrurrrr��Brit was acknowledged 6efota ma
�
the fp�rgoirsg instrument was acknowledged before me
this U. day of I\10V • 2i) 17 by
this day of NOY�_ , 20� by
.
�nuid Prnc��.
•�auid Prad2
Name of person ing statement
Name of person aking statement
Personally Known OR Produced Identification �„•
Personally Known ,m�,OR Produced Identification
Type of Identification
Type of Identifltation
Produced..
Produced
(Signature of N ry Public- State of Florida)
(Signature of Nat•
'
Commission No. - K IDMAN '
Commission Na,
KELLY WIDMAN
•'�•t,x. � °6''-. •Notary P.ub�6eSI)!te of Florida
_
c - .Notary Public -.State of Florida
, - ••
E - � � Commission # FF. 929255
°°�,� My Comm. EzDires Oct 20, 2019
'_• ; • : � Commission # FF 929255
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REVIEWS
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PLANS
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REVIEW
REVIEW . • •
REVIEW ,
REVIEW
DATE
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RECEIVED
DATE'
COMPLETED.
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