HomeMy WebLinkAboutBUILDING PERMIT APPLICATION' SCANNED
BY
St. Lucie County
ALLAPPLICABLaNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1
RFCFfV
Building Permit Application *01, FO
Planning and Development Services Pe ' �
Building and Code Regulation Division' i�'/ng 10jB
2300Virginia Avenue, .Fort Pierce FL34982 / �b� rpm
Phone: (772) 462-1SS3 Fax:(772) 462-1578 Commercial d Residentiiinv, elf,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Legal
Property Tax 1Dfh 43'iQ q31 0002 — 020 = 1 Lot No:
Site Plan Name_: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�oncrctc r�sioratiD+� +0 base-nn►cs 50U) 50'1, 510 , 5P-
Aoaltlonal WorxeQ'ee rn7rmeas Yuuerunrpcpnu—,.,mrwmI rrIr.
❑HVAC []Gas Piping L�JShutters
❑Windows/Doors
Gas Tank
[:]Sprinklers
E Generator
[]Roof ftoorpitch
Electric Plumbing
Total Sq. Ft of Construction: ,
Sq.
Ft.of First Floor,
Building Height:
Cost of Construction:$ ���$10.
aS _ utilities:
Sewer LISeptic
C,tyi Stater Address: 3D M00111 MY # SIH
Zip Code: 3A911 Fax: City! ja%.iG State.
Phone No. 41A— 91%4-930 Zip Code: Z13Z4 Fax: q"-to0J—S190
E-Mail: 1166SSA. t•l0.rIL nQ]]gekl¢-�OYn Phone No. q-rLf 5$3-Lo04A
Fill in fen dmpie TMe Holder an next page I if different E-Mail: - -
from the owner listed above) State or County License: t s"-P
Is S25oo or more, a
"° LmpJ°udu1C I MORTGAGE COMPANY: Not Applicable
Name:%iGCpr,Lb,u rtnl A;<c•�olet Name: N�t�
Address: 2 • Ntil7cin Ed S+z i rI Address:
City: 0'i-W —r= State: rL._ City: state:_
Zip: 2 11 I,�I Phone T A� - ; ;t, G n Zip: Phone:
FEE SIMPLE TiTLE HOLDER: _ Nor Applicable BONDING COMPANY: Not Applicable
Name: 0l ' Name:_ _ N IW
Address: Address:
City City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACiOR.AFFIDVIT: Application is hereby made to obtain a permit to do the work and Installation as indicated.
I certify that no'workor Installation has commenced prior to the Issuance of a permit.
St. Lucie Coup makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is In conflict with any aapplicable Home Owners Association rules, bylaws or an9covenants that may restrict or prohibit such
structure.. Please consult.wlth your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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,
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 inspectlon. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owned Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORID
COUNTY OF FAct,lrn, �2G Cvt
STATE OF FLORIDA
COUNTY OF
The for oing instrument was:ac nowledged before me
NoV'QLM
The forgoing instrument was acknowledged before me
this 9 dayof NoVeirb-ev by
this_of ^ 201�jby
.201Q
ir-kark "L6 I!-4k
SC044 J�ski V • P.
Name of person making statement
Personally Known _Y. OR Produced Identification _
Name of person making statement
Personally Known OR Produced Identification,
Type of Identification
Type of Identific fion
,
Pr duced i
Produced nf�il
.. ..
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.•""N "' RRISTINAROMAN
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(Signature of Nota - SPNOTARYIPUB
Sig at re of Notary Ie o C I i GG 227786
.?or r}` My Comm. Expires Oct 7, 2022.Commission
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Commission No. Bonded throughi(Seal)NauyAssn.m#
GGO15495
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DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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