HomeMy WebLinkAboutBuilding Permit Application 1 II
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Ls— k' k� Permit Number: I 00
RECEIVED
'C I`..1 IN1 T Y. ` V APR 01 2016
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Building Permit Applicail$. ,cgieDCountyartment
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1/-
PERMIT TYPE: ec4,c
II RCiP.fJ`.SED1lN;PRO gifil 1T,LrMATI'ONg , - e °a'I,• e
Address: /gPS Ceve,,-14 „/ /::::2„,..„„,..„ ,?9v 1 .
Property Tax ID#: X3/?— 9/y — 0004 — 000 — o Lot No.
Site Plan Name: Block No. ll
Project Name:
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SAILED DE-SC'�IPTION 00( °WORK° .°
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CONS,;RUCTION'INFORM i—,ONo ° :a. "9.° °� `^ ...
Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /06, Go Utilities: _Sewer _Septic Building Height:
OW ER/LUSEt''' , :1: 'CONTRACTOR: g:. ., ..;.,;!4.7% , ,o:a t
Name moi( /c%rel i &� /,;,s Na 47,- c/cu/./.'e / cce,.v.«.r enc,
Address: AN 7y/ Comppa(PA�4e/ .,/0 /17< ci
City: ci Avec AZ State:/G Address: /430 24,,,J 14,,..4./ ca,..-,
Zip Code: ' '3.Vvd% Fax: City: fir/ Alle/<c State: AZ
Phone No. 77, -o?/a 97// Zip Code: 3y5'°/9 Fax: 72� -?5'a2-/6
E-Mail: Phone No 7V-3 Go ,3 9
Fill in fee simple Title Holder on next page( if different E-Mail Apr,,,,- PA.,�„«J‘fr:,ie/,ces-Ac Mei
/3 767/
6,w,,from the Owner listed above) State or County License �►
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.
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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 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.
Si nat/r o Owner/Less Contractor as Agent for Owner Signatur- of Contractor/Lic- se Holder
g / g g /
STATE OF FLORIDA STATE OF COUNTY OF FLORIDA r ' .
COUNTY OF ws`
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged before me
this L day of JN, r ,2ftf 7by this / day of _- ,20 1? by
rt1C - MO S C\c�aLQ
Name ofperson making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden�. 'cation Type of Identificatio
Produced r1.--\) Produced -FL., q__
4111
(Signature of Notary Public- ate of Florida) (Signature of.Ilotan�Publi.c-S ate of Florida
41,1P+,,, ELLEN VAUG N
Commission No. +��++ ELLEN UI HN oto `B
kol p, Commission�VOa \":State of Florida-Nota4 f�lic
o %" State of Florida-Notary Public =*�.=11•; Commission #GG 270079
_'* ''—"�.�e` Commission#GG 270079 1toF„ � My Commission Expires
1 My Commission.Expires '''n+,a�'� Ictober 22, 2022
nn��` October.22, 2022;: r
REVIEWS ISOR PLANS VEGETATION SEAT T NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 9/26/18