HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSCANNED
r BY
'Sh Lucie County
ALLAPPLICABLE INFO MUSTBE COMPLETED FORAPPUCATIONTO BEACCEPTED p
q t
Date: Permit Number:
N�4 RFCF�'�D
Building Permit Application i99 j'r1o�o
Planning and Development Services <"CieD0.00
Code Regulation DrYBion - ` -' CO�nly eot
Building and
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
USE
Address: Ihq,1A S. QNOA t 'ye- Reaeb. fJ 8k9S'I
F.63rn
Legal Description: 301 .0 OF SO 10 13.0
Colt
141-h Am, OF 6w-r Lor 0. Lyfa E or- 0114 140 InQ61 uo-rv- I?tn z
-Property Tax ID #: L 3,)Q 31 ' 0100 a - 02 0 -1 Lot No.
Site Plan Name: Block No.
Project Name.
Setbacks Front Back: Right Side: Left Side:
Now, 11
6f cre k rtsFora-16ty\ +Q ba c shies —j oa I 1 a-i I'10(0 1 —I O- )'1°
PP
ormed-unuerrn-e y:.E]❑HVAC
as Piping 0Windows/Doors
❑orkiiw
GasTank —Shutters
1_3Plumbing []Sprinklers n❑Generator ❑Roof O 'RoofpftM
Electric
Total Sq. Ft of Construction: 2 So. Ft. of First F�lolor.
[]Septic Height:,
-Cost of Construction:5l (J,IO^ �j _ Utilities:Sewer[ Building
WIN
Name
lAJri aOa+
Name: J�C4H IySiin
company: tlTl lsind.{iavARCtVna(eAuiM2
Address:`1061 .St4dAnni:i.
Address: r1 �o � 1 Sk _ Ntrl '13
Stater
Zip Code: Fax
City. la"it State:j& ,
'tpi- 214- AS3
Zip Code: 3132 N Fax: qSN-(e0 1-Sl?O
Phone No.
E-Mail: &,&SSA Uoury
Phone No. Itsu. 5137-ton4N
Fill In fee slmple Tide Holder an next page (H different
E-Mail: `l
from the owner listed above)
State or County License: ! t1
If value of coils truNon Is $2500 or more, a RECORDED Notice of commencement Is required. :
I) 1
����� r=,ru.uc=,�: _rvctappilcabiz MORTGAGE COMPANY: Not Applicable
Name:�IG(arJ4,u rlr i is;Cr.,•5nJ•< Name:
Address:2;<<� N r4rnt R f Svt ! t
City: Address:
(.itdvuin.ltF Stater_ City: State:
Zip: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: > 1 W
Address:
City;
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: NIW
Address:
City:
Zip: Phone:
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain.a permit to do the work and
I certify that no'work.or installation has commenced prior to the issuance of a. permit.
zc. woe s.oun make no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is In con. tit wit applicable Home Owners Assocation 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:considera`tion 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 huliding permit applications are exempt From undergoing a full concurrency review: room additions,
accessary 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
mprovementsto.your pproperty. ANotice of Commencement be recorded and posted on thejobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commen in Work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
Signature of ntractor/Ucense Holder
STATE OF FLORIDA r_
�a �� 4CV`
STATE OF FLORIDA
OF
COUNTY OF rr'
COUNTY
The for oing instrurn_ent was:ac nowledged before me
The forgoing Instrument was acknowledged before me
this 9 day of NOJ2in tst✓ 20 It by ' -
this _n-day of � N6427wt -20 -bby
.
h-10.1r�C 11`ti lSlrl
ScQ+! J�skin , V • P.
-- 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 tion
P duced
Produced N 114
.,
/ ,....i+,.' KRISTINAROMAN
ru"
(Signature of NoWT'fi�Gd6)adt
Signat re of Notary o c I r GG 2277g6
r}',!' My comm. Expires Oct 7, 2022.
ARY PUB,,�fitIC?a
Commission No.E OFI.'ORIDA
Commission No. _"�eonded terough:(S$el) Napry Assn.
n:GG015495320
nson
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/Z/17
I