HomeMy WebLinkAboutSUBMITTED PAPERSAll APPLICABLE INF,QMUST BE COMPI ) FOR APPLICATION TO BE ACCEPTED
Date: `f
SCANNED Permit Number:
BY
St. Lucie County / J a ,00 (Q
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR:
Address: {oO0 DL
✓C—� - 35'9S
Legal Description: ZO% O
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L LU // // C w� %✓/% /2EZ
Property Tax ID #: %O/
— z9,016 — Lot No.�_
Site Plan Name: �D
vdr- c7L!/A Block No.
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C� Project Name- 4,1z/✓C-7L
Setbacks Front Back: Right Side: Left Sider
Additional work to be performed under tis permit — check all that apply:
_Mehanical _Gas Tank*,_Gas Piping _Shutters rWindows/Doors
_ Electric _ Plumbing
_ Sprinklers _ Generator _ Roof
Total Sq. Ft,of,Construction:
Sq. Ft. of First'Flb&"'� •:�////%
Cost of. Construction:$
Utilities: S�.";Septic '.Building Height:
R.
RHEUM I NEW 11111
Name r ✓C7/ GC- <
-7Z_
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Ad&ess: 3i *
Company �+ C
City::_ / /AL✓91�f% .
State-J'
Addrlel�'-s: /�i� 9J07, S ',i�a rti►s 6 !u<�y /0�1-
City,&;i �`C2 State: /•"-
Zip Cdde:•- • yy S�i!5< Fax:
Phone No.
Zip Code: 32f 9?,Ys Fax: %7a-V1W--;?7ido
E-Mail:
Phone No r%7o? - ,? 799
Fill in fee simple Title Holder on next page (if different
E-Mail222&XL Oh,de-Q pQCSifs,' C.9L opi
State or County License EC /30o- A45 9
from the Owner listed above)
z� a1,17,11Y -
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
vGJII]IYLR�GIY�]IIYGGRG !�( rvoi Appucaole MORTGAGE COMPAN _ Not A plicable
Name: /7 Name:��—
Address: Address: 2 0
City: State: City: ���/%ii �ccrr State:
Zip: Phone Zip:_¢•��Sp
FEE SIMPLE TITLE HOLDER: \z' Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY: )<Not Applicable
Name:
Address:
City:
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 andcovenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration 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 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 Notice of Commencement must be recorded and posted on the jobsite
before the first inspe. If you intend to obtain.financing, consult with lender or an attorney before
commencing work or rec rdine vour Notice of Commencement- /1
Si n t re of Owne _ ent/ Lessee/Contractor
Signat r Contractor/Li a se Holder
STATE OF FLORID
STATE OF FLORID
COUNTYOF Gc�J
COUNTY OF�w
The forgoing instruTentwasacknowledged before me
The forgoinginstru entwas cknow[edged before me
thisL1- day ofL/ , 201Aby
this Ltday of 20-& by
(Name of person acknowledging)
(Name of person acknowledging)
X\N1 T'y UI�U��i�
, 11(IUi-" Iljfu�
(Sig)ature df Notary Public- Stg0 f � � pN,,• 4/�
(Signs ureof14 taryPublic-Stateo� �3�,,,,IIp�C
Personally04
Known ✓ Olgro
¢Is�cAl�ehPitap _
Personally Known •,
✓ OR P �uca�
Type of Identification u
''��
Type of Identification
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Produced , .
Produced s*:
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( �. - F 138777 " �Q`.,
Commission No: ��q rfi&AM%\• Q`
RFF 138777
Commission No.
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