HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1I3I1� Permit'Number:
RECEIVED
•
Building Permit Application APR ® 3 '019
Planning and Development Services ST. Lucie County, Mrrnitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential VV
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: �s2. Ar4u" S-t- P0,0- SJ. 'nLucle F-t- .,T is
PropertyTaxlD#: � — �✓��� J� LotNo.
Site Plan Name: W/Fidow 9_1-p1ACQ.MffJ 4- Block No. 6
Project Name:
DETAILED DESCRTION.OF WORK
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CQNSTRUCTION INFORMATION: {
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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:$Q, �.5 . �— Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE ° ti CONTRACTOR Y
A
Name'X;W 9,t'-_1 we'e. 1J 12— Name: 305 1A- SA JCtAG 2-
Address:
Address:`€` -SLJ a Company: -SMS C004mc_-�ar's C40-ou p
City: State:_C Address: X33♦ LC ke34tr 6"
Zip Code: 114 1? ® Fax: City: wc- P4I M 6C-pack Stater
Phone No. a- A t4!P6'0_5_ Zip Code: 3 3��3_ Fax:
E-Mail:J-Ald Jtq J C43 41)1_ , Phone No 36S-7-01 $e+ y-
Fill in fee simple Title Holder on next page(if different E-Mail '1M:SCoN 4fa CfO f9eff Oy1W(PA C4 . to AA
from the Owner listed above) State or County License 666 IS 2`f9 2a
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'CONSTRUCT,I,ON LIyEN LAW INFORMATION
e
pp MORTGAGE COMPANY: _Not Applicable
DESIGNER/ENGINEER: _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 Count 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 RECORDIN ,XOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature f Contractor/License Holder
STATE OF FLORIDA STATE OF LORIDA
COUNTY OF V APRT j COUNTY OF
The forgoing instrument was acknowledge ,before me The Zing instrument was acknowledged before me
thisday of V0,kT)A .20�� by this( YID day of KU-A ,A ,20� by
�J;�tict ftS'h,�c�� '1 l�S�,
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known ' OR Produced Identification
Type of Identification Identification
Produced GIORGIA GRAC AProdu ed
Notary Public,State Florida a a�, ` "�� K
$ Nota
Commission#GG 2ot2 s''`� � Notary
SOEM My comm.expires Feb.12,202 Commis:.:
s. My comm.expira;
(Sigdatumof Notary
rPublic-State of Florida) (Sign ture of Notary Public-State dfFrbrid'a
Commission No. (Seal) Commission No. (�� � I Z (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/1/19