HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�J
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n'/
Date: - - SCANNED Permit Number... 12) 1' l� nlot 76�
BY
" St. Lucie County REcFn'ao
Building Permit Application a NOV L91�
Planning and Development services Pe
%t9
Building old Cade Regulation Division - S' 4, 9 0 pa
2300VirginloAvenue, Fort Pierce FL 34982 t e Caun,, ent
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal De:
i41 H Ala, aF 6zovT Lor a LYG tF oP aia g-4o,faC) Wf- a074- l0sn:�
Property Tax1D#:'L-43'a 0002-020=1 Lot No:
Site Plan Name. Block No.
Project Name:
Setbacks Front • Back: Right Side: Left Side:
n.cre.)c rts+t,Yi fio n }o baQcAn►ta. i—f / l-loa) HO'Cri igoB, Nl r
Q t W :
ono wor a rme s un er ispermn- checka app v. '
HVAC GasTank .❑Gas Piping j�_Shutters ❑Windows/Doors _
Electric Plumbing ❑Sprinklers CGenerator []Roof = Roof pitch
Total Sq. Ft of Construction: SQ. F��t. of First Floor:
Cost Of Construction:S ? R10• �3 Utilities: 11Sewer Useptic Building Height:
may; 14 -ail &tkrk State:
Zip Code: Fax
Phone -No. 4 -i-
E-Mail: g -sem work eoaill wxiq �GVn
Fill in fee simple Tide Holder on next page (H different
from the Owner listed above)
or more, a
Address: 511-50 WtkU I(Lldrt ntii -.2i3
City:-DMkAc. Stater
Zip Code: TH_ Fax: qS4-007-5700
Phone No. gTLI-597-1004
E-Mail:
State or County License: f�
UcalunitH/tNC71r:-'ER: Not Applicable
Name: FdG(,av Jet Ind g�SC'w,n u's
'AddreSS: 2. cCr N& 'rti,'rq Pa Svc jot
City: e.w-yQxhlrLi State; 711-
Zip: 21-1t,Li Phone ; 3t, 91 7
FEE SIMPLE TITLE HOLDER: _ Nor Applicable
Name:_` Y:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: NJrr
Address:
City: State:
Phone:
BONDING COMPANY: _Not Applicable
Name: N I A
Address;
Zip: Phone:
•-�xsy ....�. r nn i ynssrrtusn s: Appucation is nereby 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 ermit holder to build the subject structure
which is in conflict with au applicable Home Owners Association rules, bylaws or ancovenantsthat may restrict or prohibit such
structure, Please consult..w tl , 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 followingbuilding permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences,.walls, signs, screen roams 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
improvementsto.ytiur 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 art attorney before
commencine work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature oV ntractor/License Holder
STATE OF FLORID 2 tt__
4-r- rk
STATE OF FLORIDA
COUNTY OF
COUNTY OF To-L Y1 1 t>4
The for ping instrument was.�ac nowledged before me
NOVO-M
The forgoing Instrument was acknowledged before me
this 9 dayof N0V¢is, 20!0 by
this_ tfayof 20_1_bby
)ev
Ma.t�k ;���alsh
sco�.lUstiat v.P.
Name of person making statement
Personally Known _ OR Produced Identification _
Name of person making statement
Personally Known V OR Produced Identification
Type of Identification
- Type of Identific tion
Pr duced _ I
1
Produced h�Yl ..
KRISTINA ROMAN
(Signature of Note ' -S ftridClark
Signat re of Notary feo 1 fGO 777:
!
�,uYs My Comm. Expires Oct 7, IAss .
NOTARY PUB,�fIC
Commission No. TEOt� .`ORIDA
Commission No. eonded through!(8eall) Notary Assn.
ComrA GG075495
lad '
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Rev.8/2/17