HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE-ftk) FOR APPLICATION TO BE ACCEPTED
Date: .11. 1 .1 - -) '?�
SCANNED
BY
St. Lucie County
Permit Number:
Building Permit Appli
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
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RECEIVED
on NOV 19 2018
IPermitting Department
St. Lucie County, FL
Commercial L'�Resiclential
Address: k5'7SO 044ea e 14 il
Legal Description: 12 3 -T 39 Tc A/ .-P mr- Yq -/.Jr/ f-2. V.;/,
1, 4 C,./ Z' S'r r, / q, rl , A 'r lr"rl zWJ C&ua/ r'A.-I 'f,'f AAS`/A� � Zes-r �_r 1, a, R*J �bpmr C"4'
Property Tax ID #: -L3 / 7- — - &;�,Pc0 —C�oa— &q- Lot No.
Site Plan Name: IQ/,, A -Ae'r6 m3J, / It) C Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
—Mechanical
Tptal Sq.. Ft of CoKstruc .
CosiO Ifoh.structio'n.,
GasTank
,?.Iumbing
' t
In: V1 c,, 3 2-
— Gas Piping
— Sprinklers
Shutters
2- 2-
q. Ft: o t' hoor:
f-Firs
Utilities: 'Sewer _S.eptic'-.�,
Height: 241-7
r@-,WT*',NE RE—SSE1
W- ON TM
Name/,4/44
Name: (5,s74� -q sy,2- r
Address: 2 -'141 S��
Company:
City: 44 9 Ile.-W, A- State:
Zip Cocle:_?22 12 Fax:
Phone No.- 9S4(- Y2-F- J,?11b
Address: 3q2-X S— -7? W4,,AL
City: W.V- ell)� State7L
Zip Code: 31e919 Fax:
Phone No 7W - JW-.?
E-Mail:
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail I, eb--,
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
"U RUIEM ENiP7LKC--ONSiTiRUI:C-iTilONIL11 ENIM11 N
F.0 R M Mi I
DESIGN ER/ENGI NEER: Not Applicable
N a M--d:' '9'
MORTGAGE COMPANY Not Applicable
Name:
r e s's 7,
Address:
City: State:
Zip: i� T.h9ne i
City: State:
Zip: Phone:
FEE SIMPLEJITLE HOLDER:,,q i Not Applicable
iz." 1, '; 1� , : J...'� D
Name:
BONDING COMPANY: Not Applicable
Name:
'!;iT-1
Address::
-Addre -
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration bf the granting o his requested permit, I do hereby agree'tha t 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 Noticg� Commencement must be recorded and posted on the jobsite
before the first inspection. If you int9pldto obtain financing, consult with lender or an atto�nq�tefore
Signat wner/ Lessee/Contractor as Agent for Owner ign r/License Holder
U;WO !��f.Contracto
STATE OF FLORI STATE OF FLORR
COUNTYOF
COUNTYOF
The Ing instrument was acknowledged before me The forgoing instru#iprit we knowledged before me
V ac
forr Ir"
this day of 201 Y by, this ' 0"a 4� -
_J�u y of 20/Fby
,A
aW4 r
e,4 Ir L a SA
Name of person making statement. Name of person making statement.
P6irsonally Known ificalitan Personally Known OR
Type of Identification ... RICKY CARL COCHRAN Ype of Identification RICKY CARL COCHRAN
Notary Public - State of Rork
Produced— Notary Public - State of Florida Produced
ion It GG 172136 - , I i'mmisson 0 GG 172136
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26,20
MY=xpires Apr 26,2022
- - - - - - - - - - -
(Signature of Notary Public- State of Plorida (Signature of Notary Public- State of Florida
Commission No. (Seal) Commission No. (Seal)
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