HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
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SCANNED
BY
St. Lucie County
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCATiON TORE ACCEPTED
Date: ' ' Permit Number: ,n Dqi
PerMi
4In9
Building Permit Application Sc p
Cucie
Planning and Development Services C061)y ent
Building and Code Regulation Division -• -'
2300 Virginia Avenue, Fort Pierce FL34982
Phone: (772) 462-1SS3 Fax: (772)462-].578 Commercial Residential
PERMIT APPLICATION FQR: To Select from dropbox, click arrow at the end of line
Address: Ing'jR-S• O&O� n 1 'ye. .6%, gendi,, fl JAM
Legal Description: 0 .0 OF SL .02, FT,
-AL-6 Ala, Of 610VT Gor .2 LV6 F OF 141A 1�io'Ae1 (��2 ao74- latn.a
Property Tax ID LIS12 131 — 0002 — 020 --1 Lot No:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Coricrctc V-tS+ar&Ai1bn +0 bOAC-15nics LP03-1 ( Dq) Job) (01
apply:. '
AUCHEIGnal won a orme : un er cs permit— ec a lIn—❑Windows/Doors
�CIHVAC LjGasTank ❑Gas
Piping _Shutters
[]Electric ❑_Plumbing OSprinklers ❑Generator ❑Roof Roofpitdi
—Total Sq. Ft of Construction: 5 . Ft. of First Floor:
CostofConstructiows �50. Pis Utilkies:12SewerOSeptic Building Height:
Name: `Y_0�t t1JL5'ftn
Name
company: a��tStlsrO7qS4—(#0j-q12O
Address: 1001 S-"1Fi4'1B.n— �,/f�#�ao1..
rhl 1� State:
Address: A93o jplyfiZipCade:
Fax:
City:, �i( lviC
PhoneNo.'4a1-2'IN-13S3
ZipCode:A132N
Phone No.
E-Mail:, �A- ^�SQ�Q�1L n��elt l� • �OhL
Fill in fee simple Title Holder an nut page (if different
E-Mail: TO
from the owner listed above)
State or County ticense:C& is J
H value of construction is $250o or more, a RECORDED Notice of Commencement is required.
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Not
City:
Zip:.
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:__. f1�q
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: N�ti
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: NIA
Address:
City:
Zip: Phone:
•,.4,y ... ,N a ry a wn nrrwvl I : Application is hereby made to obtain.a permit to do the work and Installation as indicated.
certify that no;workor installation has commenced prior to the Issuance of a permit.
St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is In confllet with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure.. Please consult.w thyour 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 1 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 undergoinga 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
improvementsto.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
commencing work or recording vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
STATE OF FLORIQ&
rF>oLn
STATE OF FLORIDA
COUNTY OF
COUNTYOF
The for oing Instrument was ac nowledged before me
The forgoing instrument was acknowledged before me
q dayof KOVOiw by -
this_ntlay of Mf)-4tM, .20IAbby
this Y .2016
Mark l 1'LLIS l
Sco+4 Jt,ksk vt
Name of person making statement
Personally Known_ OR Produced Identification _
Name of person making statement
Personally Known \./ OR Produced Identification
Type of Identification �
Type of Identific flan
.
P duced I
Produced n1�1i1
1�,:`yvL_KRISTINAROMAN
'n"�CdClark
(Signature of NoVNOTARY
Signat re of NotaryW1998... ttnea
mm. 6pires OctCommission
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PUB IC
No.TE Of1.�RIDA
Commission No.ugh r(Seal)Nocary
m#GG015495
REVIEWS
I 7NG
S..... OR
VREVIEWON
SEA
MANGROVE
CFRONT OUNTER
R�VIEW
REEW
REVIEWTURTLE
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17