HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4Q
Date: 2 -2S-- I q Permit Number: (C1.0%:
L RECEIVED
Co o N :' r FEB 2 6
1018
��- — Building Permit Application
Permitting Deportment
Planning and Development Services St.Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: Douce
PROPOSED IMPROVEMENT LOCATION:
Address: (00`1 cE N i de," g it-r I riV -
Property Tax ID#: •3'-1 7 — 7' I - � 3- poo -3 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
f-0-91ac.-6 a loot.a Er Doors I I Ole f�,��,ac,�-. 1 Lou.) Pr F►Ler 3�,•�
CONSTRUCTION INFORMATION:
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: $ � �pD Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: nn CONTRACTOR:
Name " •---.Aa Name: GYsz-o...- 1.,y., c --
Address: Lobq SE. 14itl4i ' flr Or . Company: - - - Se--vS —r- -,c..,.
City: ParState: a. Address: Si ( SW PSL Q(vrL•
Zip Code: 3yq 3 Fax: City: eorf-S-(-. 1�cc -e. . . - State: Pt-,
Phone No.-1-1 L- Loci aAL 11 Zip Code: 'I,'( 1 S2. Fax:
E-Mail:Gl1owizal auao/%#:rrs ep&.IlscLi.-11n. rt4 Phone No -11"2--3 3(c- 1 Lo 3
Fill in fee simple Title Holder on next page(if different E-Mail 1 es"---3
from the Owner listed above) State or County License C.C&G ci 3 a 3 z,.,•
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:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: 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 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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
/A.& e.
�l
Si:nature of Owner/Lessee/r'ontractor Agent for Owner gnature of Contrarr/License der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF g} LAA,C I'e. COUNTY OF (St MAC%
The forgoing instrument was acknowledged before me The forgoing instri.Jrnent was acknowledged before me
this.$ day of Ie,brL4a*l ,2019 by this 2,5-day of e.iOC av'( ,20 1c( by
Jolf‘n AM-In On roe-Cl_ Z-t nn Prinl-InON9 6roJCL
Name of person making
statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known `0/. OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of tPublic-State of . �. kiRIANNAGRAHAM (S�nature of Notary Public State o BRIANNA GRAHAM
r 1� MY COMMISSION#GG089105 ?' MY COMMISSION#GG08910!
06.-- - . EXPIRES:APR 02,2029 05-
°F„,
IBES;APR 02,2021
Commission No.6O$q I „}• ��dnded through 1st State Insurar � mission No.6G 0%9 I W oF rIthrough 1st State Insurance
l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7119