HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: SCANNED. Permit Number: I IQ--o!L�
BY
St. Lucie County VEr
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irECENED
Building Permit Application r Pp ,
Planning and Developmentservices Vt'p ?0I8
Building and code Regulation Division P P. ua:pm....
23000rginiaAvenue, Fort Pierce FL14982 t, c ou ryeet
Phone, X(
(772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 51 Or+h Ricly1womA l r FL JCI
Legal Description: QG2 0 ^O . IAIC RecreA fWell) 16
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PropertyTaxlD#: ! ^ �� 2. QOGY�-(SQ(� - �j : Lot.No.
Site Plan Names i)eeayl .. Sa: CuroP,)r)(. &alZ4/LtVl6 (( kNo.
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Project Name: Oceu.n oY 0-i'wIAP
Setbacks Front Back /' 4 ,Right Side: A LeRSide: N : 6
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Replace .exis-�'n5 ret-t�.iniVl� wall a1�d �. i�nSame �u�c�
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Additional woricto e performed un ert is permit- e a apply:
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L IHV)C ❑Gas Piping In Shutters LlWindows/Doors
Electric ElPlumbing Sprinklers 11 Generator D
Roof Roof pftch
Total Sq. Ft of Construction: So. Ft. of First Floor.
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Cast of Construction: Utilities: - SeweroSeptic Building Height:
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Namb-opeairl (X -0 iNC
Name: 5VlVL.4P1r1zoh8,✓
Address: 5l1�I
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Company: DII L ih (if L (1 1
City: rD P erce State: -F1-
Address: 1%0R (SW
Zip Code: 5 q g r'i9 Fax:
City: Ano 9 P a r h state --FL
Phone No. 772-41&5�,'M63
Zip Code: :3- 3 (0 0 Fax:
Phone No. TM-5(o 1-r78Qp
E-Mail:Ij 6�10f'e,S6K%ftIarIRGe( .Cb-M
Fill in fee simple Title Holder on next page if different
E-Mail: Arewoctwiiat2-Co(1S(7Llc' iM,e6tit
State or County License: Cam' 1258�
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
NotApplicable
Address:
Address:
City:
Zip: Phone_
State:
city:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER:
Name,
CLNotApplicable
BONDING COMPANY:
Name,
NotApplicable
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 commented prior to the Issuance of a permit.
szruaure. riease consum wren your name uwners Pmoclation ano review your oeeo for any restrictions which may apply.
In consideration 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 roams 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 inspection. If you intend to obtain financing, consult with lender pr n attomey before
commencing work or recording vour Notice of ComrriPnremenr.
Signature of Owner/ Lessee/Contractoras Agent for Owner
Signature of Co a
o er
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF
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COUNTY OF //I%9�i�Ci
7hefo oinginnss��nn��r,��te� wa a�m led e eforeme
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Theforgoin instru ntwasacknowledged before me
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thiM,dayofl�kJ�
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this,�of
20/Z7by
Nameofpers maIdhgstaternent
Narileofperso'rnakingstatem t
Personally Known OR
Produced Identification_
Personalty Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N' tia.�BtaAir+alWltiR
I
(Signature of N �Pg611c-State -'
OO NotaryPublic to or fl da
Commission No. �. on a Pere.
Commission No.
„Y ,,,••, BAR6ARA
�`.s ? noliry Public -!
9 1+. My commission GG 169538
Tiw Expires 171792021
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DATE
n'
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RECEIVED
DATE
COMPLETED
Rev.812117
239276
in 9. 2019