HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONSCANNED
BY
1 i St. Lucie County
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPUCA71ON TO BE ACCEPTED
Date: Permit Number:
'Will
41.
Building Permit Application .°eddy
Planning and Developmen: services
Building and Code Regulation DNision
2300 Virginia Avenue, Fort Pierce FL 34992 -
Phone: (772)462-1SS3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION F,QR: To Select from dropbox, click arrow at the end of line
-Address, IAon A S. (7N&A + Ddy,— Qa ak- , f L 3t11571
*.kn4tn
Legal Description: 0 .0 OF 5 r
ALA AlA.- OF 670VT Ler 1 LVC o� KPIA -�io f�C) C�$ Lfo ►H- I�il7
Property Tax IDfk 1I5-l2 I31- 0002 - 020 -1 Lot No:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side;
�oricrc�c res+orai�Dn {o b0Atahie-s.
..�
ono wor rme t un er is Permn- e a app y:
❑HVACGas'Tank ❑GasPiping ❑Windows/Doors
_Shutters
_.
❑Electric OPlumbing ❑Sprinklers ❑Generator Roof 'Roof Pitch
Total Sq. Ft of Construction: - Sq FtFt. of First Floor.
Septic Building Height
Cost of Construction: $ aT =. UtllRies: L Sewer
11 WA,
Name: 6to 11
Company: Q:TI 'Zot"Oy4i 1:P—C.it�a(nAviNe
Name
Address, 1001'-")RIA(ln+ie, Alf.ltk)-`
I
may; State:
Address: $ F RD
2ipCode-. Fax:
City:, 7 State.
Zip Code: 3'3 Fax: ASf—(e0--5190
Phone No.-Ig'-'-.114-230
Phone No. +t4_587-1an4R•
�Ma�
E-Mall:�js� Cl0.�k �►�tt nle1Q
Fill In fee simple Title Holder an next page (If different
E-Mail:
from the owner listed above)
state or county License: Caf�
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
Name: MORTGAGE COMPANY: _Not Applicable
Name: C(trlbtu ttr t (�i'c<• n1eS Name: r4hi
Address: a< y- N 7tr � o f S'4 I ,t Address:
City: CILd-vuL11GF State: rL City: State: _
Zip: 2 z t, 1 Phone i -; 3 s- c Zi?: Phone:
FEE SIMPLE TITLE HOLDER: _ Nor Applicable BONDING COMPANY: _Not Applicable
Name: SJ b Name: N 10
Address: Address:
City- City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR.AFFIDVIT: Application is hereby 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 Counttyy makes no representation that is granting a PFermit will authorize the ermlt holder to build the subject structure
which Is In conflict with any applicable Home Owners Association rules, bylaws or ancovenantsthat may restrict or prohibit such
structure.. Please consultwitlt. 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 (will, in all respects, perform the work
In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
Thefollowing 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
improvementstd: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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of ntractor/Ucense Holder
STATE OF FLORIDA
?RAry1
STATE OF FLORIDA
OF
COUNTY OF
COUNTY
The for oing instrument wasackknowledged before me
WoVernVXJ-1.2019tby
The forgoing instrument was acknowledged before me
this 9 dayof NoVeiAbry by
this_'dayof
.2010
�0.r �.1�a:1S�'1
Sco+F Jc.skivt , U 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 ldentific tion
P duced � I
Produced nf�ii
- ..
...
KRISTINA ROMAN
7t�GdCJarlc
(Signature of Noi&NOTARYPUB
Signat re of Notary le o c I �i I GG 227766
n„•'' My Comm. EzDires Oct 7, 2022.
IC?a
Commission No.TE OE'I .. RIDA
Commission No. "`Banded Nraugh KS>3a1)Notary Aan.
omm#GG015495'20-
EWS
FRONT
SUPERVISORNING
PLANS
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S REVIEWLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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TED
Rev.8/2/17