HomeMy WebLinkAboutBuildling Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i ? ji
Date: ( " 19 Permit NumberCd/
RECEWED
,IC JAN 3'1 1019
F L 10 R 1 1, ti
Building Permit Application pert
„nment
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)4624553. Fax:11(772)462-1578 Commercial Residential )(
PERMIT TYPE:
PROPOSED INPROVEMENT LOCATION 'tl' '
Address: ULit i r ck t rl Qao,Y Po-c si-
erty Tax ID d
Pro 3 ��^ �C7aCD
)d2I '- ( — I Lot No. /
p
'
Site Plan Name: i3c�pcc � Block No.
Project Name: C_O Ck
DE N LEDDESCRIPTION OF.WORK
CONSTRUCTION,INFORMATION Y w ,
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
. Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: .
Cost of Construction:$ '-•O(5b. 0i) Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE aQ `CONTRACTOR•
Name SNNe,rtt hroc� Name: )416L&e t &elpJi (O
Address: 'C(3-7 14u it c,119. 70' Company: 44e e. F . clA,4 Sec, 1f2v Lc (vac_
City: p„, 5- Vic,-� State:_L. Address: c i \60 r=torAc.\-c. �v--
Zip Code: 3 *9 Srb Fax: City: 9c, S\- 1v c .'-e . =. State: FL
Phone No. 7`of0 Zip Code: 3 49 g3 Fax:
E-Mail: Phone No -7-7 343--75
Fill in fee simple Title Holder on next page(if different E-Mail A ce pea is c ( ct-vt • ccsr1/4-,
from the Owner listed above) State or County License 2C t k -? 3 3 D.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN •LAW INFORMATION
Pp MORTGAGE COMPANY:
DESIGNER/ENGINEER: _Not Applicable Not Applicable
Name: Name:
Address: Address: •
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: .Not Applicable
Name: Name:
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in confli
ct 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 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
' /, •// ' ►� '
Signature f Owner/Les ee/Contb tor as Agent for Owner Signature of contractor/License Ider
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -J r L it_C t' COUNTY OF S- Lt C(/'_
The forgoing instrupgent w s acknowledged before me The forgoing instrument was acknowledgeOefore me
this, 1 day of L , 20 / by this 51 day of 3.JLI ,20 / J by
r /
LC,In n Geb,tchn Al « e Q . Gaut&0
Name of erson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification n Type of Identification
Produced f/(.______ Produced PL L
___ __e_Ak - ---- ekt CLU-fr---- ______________
(Signature of Notary p� �'• , • oLidz)., (Signature of N...._ •�. :State of Florida)
,,,,$.1:4L,, ELLEN VAUGHN . `s YPG
Commission No. ,34%,;\��.State of pe Notary Public t Commission No ?'2 i9<ga ., ELLEN Vt(_..;:IN-'''. ..
• *'!^'o Commission #GG 270079 p!��� Com—f•Fforida_Notary public
'r , MyCommission Expires 5• II o mission
'i�OFFIO`��� P %,OF ROe`\ M ...._ GG 2701
'«����" October y2, 2022 •n r
�,� ' October 22, xoires i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO •' ''n - i.!: t ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW - fIEW
DATE
RECEIVED _
DATE
COMPLETED
Rev.9/26/11