HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSCANNED
BY
St. Lucie County
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED n
Date: Permit Number. lX a
RECEIVED
Building Permit Application Nov 13 2018
Planning and Development Services _ Permitting De nt
Building and Code Regulation Division, - St. Luci Deep rime
2300 Virginia Avenue, Fort Pierce FL34982 / ty
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal De:
►[-k
-lotnr
PropertyTaxlD# L13")2 131 - 0002 - 020 = 1 Lot No:
Site Plan Name: Block No.
Project Name: '
Setbacks Front _ Back: Right Side: Left Side:
ere -At rla1701'diiDn +0 baQcAhics AOle) 081It2,-
UHVAC L.,1Gas Tank (JGas
❑Electric OPlumbing ❑Spr
Total Sq. Ft of Construction;
Cost of construction: $ _ oi- E 1 � •
Piping
ers LJGenerator
gnFFt
Soffirst Floor. _
UtilitieSewer Septic
Name:
Windows/Doors
Roof = Roofplldl
Building Height:
may. _Stater Address; 5931) }p)_yt7W i(Cn"LAHr 1W 1111
Zip Code: Fax: city: �l a-ic- _State:LL
PhoneNo.,yle1- 11412SS3 Zip Code. 3- 33 W Fax: 454-(a0- -5100
E-Mail: &viS l!l0.YiL�ne Phone No. qcU_ 59 tpr)V_R
Fill in fee simple Title Holder on next page (If different E-Mail; 44 j 93
from the Owner listed above) State or County License:
If value of construction is $2soo or more, 2 RECORDED Notice or commencement as requweu. 11 1
f-Q?P[,9MENTAL c0NSTRvn0N LIEN, LAW 1NFOR11 AT10N 4 + U--�''%'
Name:L40C,yl4Yu (n0�GSf
Address: N rtifn Qi idt iot
City: Citr7vwauF State: T1-
Zip: t2-II,w Phone i. - , t;- q1-11
FEE SIMPLE TiTLE HOLDER: _ NotApplicable
Name: -
MORTGAGE COMPANY: _
Not Applicable
Name:_ Jg
Address:
City:
State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name: N I A
Address:
City: I City:
Zip: Phone: Zip: Phone:
)WNERI CONTRACTORAFFIDVIT: Application Is herebv made to obtain a oermit to do the work and Inanllntr �. Inds a:eM
I cemryinat no,worKor installation has commenced prior to the Issuance of a permit.
St. Lucie{ounty 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.w t : 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,
accessorystructures, 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
improvemeritStd.y6ui 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
commencine work or recordiniz vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature of ntractor/Ucense Holder
STATE OF FLORID
�Gt,
STATE OF FLORIDA
COUNTY OF
COUNTY OF m
The fo,r$Ding instrument was:ac nowledged before me
NO-4Z
The forgoing instrument was acknowledged before me
this q day of NOVQMbty .201 b by
this _'Allay of . M. 20-J$by
Main k 1l' *11`15�
ScQ+F Juskih , V . P.
.. Name of person making statement
Personally Known _)C_ OR Produced Identification _
Nameof person making statement
Personally Known OR Produced identification.
Type of Identification
- Type of Identific Pion
P duced _
Produced fy�Y1
RISTINA ROMAN(Signature
'1�EdC)alk
of NojWTEO
signal re of NotaryI IVARYPUB''��RRIC Erpires Ott T,IOtt,
Oil
Commission No.fi .Y7RIDA
Commission No.hr(9ea11NotaryAssn.
nWGG015495
REVIEWZot
S
SRESIIEVX
VREVIEWON
SREVIEWLE
MANGROVE
COUNTER
REVIEW
WOR
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17