HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z-4— l WI Permit Number: ,qU�'/ ' ��n
iiIMMENNOMMENOMMEN
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F L ID R. I co P �- = AP ,�
_ Building Permit ApplicatiorEPmrttR ®, 2018
Planning and Development Services si..L!u a attment �
Building and Code Regulation Division my
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: E( ,
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PROPOSED IIMPROVEMENT LOCATIONS
Address: /3 6 ,l/ G C., RD C deis2r
Property Tax ID#: 1 1 ':37: (er I I- -0}'"o00/U Lot No.
I
Site Plan Name: Block No. I
Project Name:
DETAILED D'EESCRIPTIOIN CIF WORK?
Grp 2 # , . , ',AP ir/F& /iiiZ (?3,P71 �.e /1r//7
CONSTRUCTION ,NFORMA ONE
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors 4
'Electric —Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �,e(2,0Q Utilities: _Sewer _Septic Building Height: '
1
OWNER/LESSEE o . ° :CONTRACT®R° • -
Name -l ' Ki.)�t L,jt- U4-LGA Name: ti005pA2 /3 (c7
Address: ./ Company: //27i'it4/ ) amk £' C RIP
City: j' ../ , 10J77(L� State:_ Address: ////f f GPf7/jy! ,5C p,7---
ZipCode: Fax Cit r �j ,/ State:
--
Phone
p 9 Y ��� l� ���' �
Phone No:.. . . �p 2/ 4 3 l f79-.4 Zip Code: 37 Fax ,3:6, ---7 602
Phone No 7 07—... .5 ?.—
Fill in fee simple Title Holder on next page(if different E-Mail__ / //7---
from the Owner listed above) State or County License LE oee 3co?
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.
t
SUIPPLMEMI gONSTRWITEE ME a1WIn I F®RMATIONg
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."
Iv Q�4 -
1Al, _ice 40 / �►�
Sign. u - o Owner/Lessee/Contractor as Agent for ��lner Sig atu e of Contractor/License Holder
ST,TE ea FLODA ST,TEOFFLO A
CO N /,/(1.......„ CO NTY OF .<. .,, ,,e.<. .,, ,,e10a..i le
OF ,(..,
' The fo Ding instrument was acknowledge before me
The eggoing instrument was acknow edge efore me this 4p-01___of , 20/ by
this Jct-day of ✓t __ , 20/Yby
c_ t
c5-\..,Q P.Q0 4?-_:CfV-J2.11.,-- Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced
Type of Identification
Produced
ciu (Signature of Notary Public-State of Florida )
(Signature of Notary Pu lic-State of Florida ) Commission No. (Seal)
:...._. ,. ,,,
"Vd'% ELLEN VAUGHN
Commission No.
41Iiii.StateEoLfLF17ida
°e,'AUGHN _°�•�� State ofFlorida-Notary Public-NotaryPublic *= Commission #GG 270079, II o- Commis , . ,r
-,,,,,,,,7,,o;\�` My Commission Expires " in Octobor 22,2 2•N
o ,
REVIEWS F1,..._..--.�_�e�kr,:,, e 22S �RVISI ' PLANS VEG I .,_ ,._jt;OVE
COUNTER ' REVI Ir - , •• REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED _
Rev 2/7/19