HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZI Permit Number: /'69019-
SCANNED
BY
t. Lucie County RECIMIED
A We— M-00
Building Permit Application AUR .10 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie countv
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:— 1:�qo DL-- IE14 12- S us flW11 K) L t--:C '�6 Y T 32.
1i r. /4tV- Cc_
Legal Description: , �.c La k4-� F ki. Z-q
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�UUI LIU[ Idl WUIN LU WU IJUIIUI I I IUU LIIJUCI LJIlb PUI I III L-611CUM Oil LildL cipply.
—Mechanical — GasTank Gas Piping —Shutters Windows/Doors
Electric — Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First.Floor:
Cost of Construction: $ :70c). Utilities: —Sevver _Septic Building Height:
INW, N E R7Z E
N�@ N TM �RAOTQ
Name �1\aA-es I
Name: �Dkf 62 eq;�
Address:—Wb T, -3
Company: Cxed 1:4bp a�d" 2�� e-,
City . -.. State: PL
ZlpCode: Fax:
Phone No.- 3 ED -11 L)Y
Address:- Gk.Y"4'1Ah4' Fet.
City: 'r-r' Tleh�e- S t a t e: -le-11
Zip Code: Zqrq.T Fax:
Phone No, P11 #66 0'�'
E-Mail: Cka(4 i'e -�OL
Gvko,�A,a�-
Fill in fee simple'ritle Holder on next page (if different
from the Owner listed above)
E-Mail dq&-n J- 4 1 1p',/ WA/. 4mr,
State or CoLty Lice'rise
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
"UP.P.,LIEME�N=MriTiRUr-C:�TirO'NILIIENIM',WIN
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. M A, 130
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
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 subj ect 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 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
improvemerggo your property. A Notice of Commencement must be recorded and posted on the jobsite
before theXrsl inspection. If y u inteno)to obtain financing, con t with lender or an attorney before
c6mmenog fmork or peordiyg your qqftice of Comnrencemen?�
I I/ - / / / I I / __7T I A
Owner/. Mssee/.MntraVor as Agent for Owner . I Sig6itureof
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instnt"ent was acknowledged before me
thjsc'�6 day of 2�1 - by
Name of person making statement.
Personally Known —
Type of Identification
of Notary
Commission No.
The forgoing instrument was acknowledged before me
this!'6 day of QLLc% 26V�_ by
Name of person making statement. 0
Personally Known OR Produced Identification
OR Produced Identification
Type of Identification
Produced
&�n k_o
?t5ate of Florida (SiWture of Notary Public- St%te of Florida
(Seal) Commission No. (.Seal)
LASHAHNA INGRA�M
REVIEWS CFRONT
OLINTE '�J._ Tini it 2 INS �VEGETATI
LJO-IN REVIEW
___ _U IEW
RECEIVED
NA