HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, (--V- - Permit Number:. (75-C)31
RECEIVED
COUNTY
FLORID A APR 0 5 2ov
Building Permit Application
Permitting Department
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:
TYPE:
PROPOSED1MPROVEMENT LOCATION':, ' ' ;
Address: /17 AGIrteirlY 7 Fog .P1Eke.:C i 3VM.
Property Tax ID if: X01 00/a-600-6 Lot to. I :1
Site Plan Name:,574c.;42/27d#0 RAU-(bur ewe- Block No;
Project Name: 69/e17R 06:411t
- , • • , ‘,67,0.,,,m‘ • '
D ETA!LEDDESCIVPflON.0 r'WORK
- k, f,..` • ;,..• •:.:---1"‘'-ttl;
AeYi:trife.Z. e.o.41:8,Z• ReciloV66 4,/1aiJoicr Room
• Bit7ifioor4 -- -RepedozerA)57A4TI613 macc,:ge Rtimeo
:',,CONSTRUCTIONINFORMATIb
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: 5Q; Sq. Ft.of First Floor:., _
Cost of Construction:$ 7Oa OC3 Utilities: Sewer Septic Building Height;..
',DANNI5R7LE6SEEk CONTRACTOR.
Namei.C1?-4?Til _ Name 57-9...w._Be4414)0
Addret.:46 : Company: 174/914) /:?-&'5/61 teMiti
City: State:FG. Address ;A:44.56.
Zip Code:34.94 _ Fax: City:. &-:-;161- _state:
Phone No,7:77,;?- Zip Code: 3, 06 7 Fax:75-1-663_-3"3:31_
E-Mail: Phone No 4 //
FM in fee simple Title Holder on next page(if different E-Mail5-40Perif7?7,4-m "Jerre.,, e,OM
from the Owner listed above) State or County LicenseeCe.a:413S
• 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.LI EN ,AWINFORMATION ' .. ,,
pp MORTGAGE COMPANY:
� _. � 3 .LL
DESIGNER.ENGINEER: 3C Not A licalile MPANY: SC Not Applicable
Name: __- . . . , _. _ Name:
Address:. __ . Address::
City:, State: City:. State:
:Zip: Phone. Zip::. _ Phone:: -
FEE SIMPLE TITLE HOLDER: k Not Applicable BONDING COMPANY: k 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 Gount�snakes no representation that ts;-granting a permit wili�autharize the permit holder to�buildorthesubJect structure ,
which.is in conflict with,any,applicable.Home Owners Association.rules,;`bylaws_or and covenants•that rtiay restrict prohibit such
structure;Piease consult.with your Home Ownerrs:Association:arid review your deed er any .restrictions wllrch may_apply.
In consideiation'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 OTIC OF C I_,w;;. NCEMENT."
.,1. - — = ah _�1 f "/ /AP
Signature of Owner essee/Contractor as Agent for Owner 'x ; : at 'e of Co,'� actor ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'j"/jiX., COUNTY OF C0in..X. . 'a_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 13_,day of *to CAtt. ,204 by this Z. day of L 4 - C-1,-) ,201'1 by
CPr V ( —f ('1` _nrit�"l`,,. t --- - 7, 3v4-') l3eAr . ,__
Name of person making statement. Name of person making statement.
Personally Known OR Produced IdentificationPersonally Known OR Produced Identification
Type of ldentif'cation Type of Identification
Producedrr-- - 0015;f4 7:/17- "4,P,J-O Produced.
-.1-'41 ' i .,
igna re of 'of y Pub `-- Signature of Notary Pub= -Sse of Fr�rgi4a4blic state of FIorida
• MICHAEL3 YORK i 4' -_�; Lose Griacom
.40."'V.; i. t My C 1 n GG 102013
Co'•mission No.. �',;r.. __ MY- ISSION#GG141678 ommission No,, 2021
EXPIRES:December4,202t
-0 t+.°, ga dedTtuu . PnbicI1W0 M*13.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
feu:2/7/�9:_ ,
I.
I
J