HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � • Ii`J' I l� Permit Number:
n 34/ably SCANNED
BY RECEIVED
Building bWNW Atoplication JAN 1 Q 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, pyrryllf:Eing
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
�PROP;OSEDIMPROVEMENT LOCATION:*
Address: !3Qq'7 -i- US NW Y 1 ay+ 6-1-Ludo IFL. a-itI
Legal Description: 52•L Q-ti-LiP.I'1PA 1_ rDn4,tl (J ny-cl
Property Tax ID #:
Site Plan Name: .
-5o1- ISO 9-4C70-0
Project Name: Joleo'rS uo"tO
Setbacks Front Back: Right Side: Left Side:
M Do) iC� (a') 2X11',Zzt n9 Gi pA- rc,0rns
HVAC LJGasTank
Electric 0 Plumbing
jermic— cnecxau apply:
aasPip ing _Shutters
Sprinklers ElGenerator
Block No.
I� Windows/Doors
I1 Roof = Roof pitch
Total Sq. Ft of Construction:
3a 00
S q.Ft. of
Cost of Construction: $ 1 A.
600.00
Utilities: er ®� tic
Building Height: pt
O,ViI ,ER/LESSEE?; ; - °
CONTRACTOR ,
Name`rSlnE1,`Lt SOn rthMa haj0
Name: Rulae.rt P memo✓ei:�)t-
Address: cd3tQlr!,.5' ({S H6L)F I
Company: D2vY,l9YP a'f'
0m*,,rrac rant!p�o�rL
City: State: �L
Zip Code: 42jj a Fax:
Phone No. 7-73 -q4o (or3oq -
Address: 900 3Mt31tn.,
, 44— UU
City: f State: FL,
-Zip Code: 3499-1 Fax: 33i920-0a.1
•Phone No. o`�iaD-00j(oS
E-Mail:-hoo Corn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: kbcLPrnO�/art Inra��[
,mSh urn is n, cta
State or County License: C-f
09 SaQ` t
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
i�
�7
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 conrlict 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 reviewyour 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 re4iew:'roorr 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
commencingwork or recordingour Notice of Commencement.
Rev.8/2/17 1
SUPPLEMENTAL GONSTRUGTION LIEN`LAW INFORMATION
+ _
� �
DESIGNER/ENGINEER:
Name:.i0sf_�►, P fYln�riu
Not Applicable
(1rr.►,L+ec��sr�. '
MORTGAGE COMPANY:
"Name:
Not Applicable
Address:QOU �ccs+ Qs�reol[��lrnat
Address:
City: 1-
Zip: Phone �-7a
State: F�—
otff'1- `t 5
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
Sig re of Owner/ Lessee/Contractor as Agent for Owner
Signature of n ract r/L ce"ns Ider
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sa- L.,1e1.�
COUNTY OF `� C.wel a
The forgoing instrument was acknowledged before me
The for oing instru ent was acknowledged before me
this,t�dayof JamL.cctru .20L8 by
this �dayof20� by
D�ry,oresd-
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification Ji �(
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced FL lif(uPr L:C2n5e-rna55-7fry-�%-5950
Produced
(Si nature of Notary Public - St of Florida )
Notary Public-
(Signature of a
r
+1�`T °oe ryrypLary public Salta of Flo
Commission No.�?e1lAronicaLTaylor
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tom issionNo.FFde619� 4:•4n /T)o(�81�GcstateofPlprida
�B My Commission FF 2251
Expires 06104/2019
2 Veronica L Taylor
"�� My Commission FF 225192
or no`
qg. Expires OB/04/2019
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