HomeMy WebLinkAboutBuilding Permit Application f
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit 1 Yl 1�� Permit Number:
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RECEIVED
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Building Permit Applicat(on APR 1 7 1919Planning and Development ServicesBuilding and Code Regulation Division LuG�e Cg4,r, ,f, rermltting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential \ _
PERMITTYPE:
PROPOSED Ii1lEPROVEMENT LOCATION .4_ f ,��r � ;.� i
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Address:``51IBJ 01e0...91tOPQ ; CrCIt µ 0ORftC FL 6ug5ls
Property Tax ID#: 1 �. -1500 00 Ar-r0`0 S Lot'No. a ,
Site Plan Name:``eppjj 01qPt��e.I �I &Iyj �(Q� Block No. E
Project Name: MGM
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CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping Shutters V//Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ a\a ,X11 of Utilities: _Sewer _Septic Building Height:
Namev,w 4 1nda 1 sm Name: \A1 C,hrl e k MI fiY j
Address: f � ., �1 t Company:ce,Iti(_i f d h-jufyu1kiI({(1 A W I V1Cr(� )us
City:HITt PiFRf- Stater Address:-100 -F C��il�'a1�Y(, . C�11it nfZ
Zip Code: COI Fax: City: Staate:_L
Phone No.1 -—,)TIFU00 Zip Code: �a 9 5 8 Fax:113 die) 8459
E-Mail:R\_W6 M V1 a G-Q�• co rM Phone No'119. D aU b'88
Fill in fee simple Title Holder on next page(if different E-Mail(OO KC(aq C Qt'hO( t�.C111 phi
from the Owner listed above) State or County License C.C1 C 15
If value of construction is$2500 or more,a RECORDED Notice ofCommencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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SUPFPLENIENT L,,', ONST'RUCTION„LIEWLAIN �I�IFORMaTION
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
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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 t
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." I
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Signat of Owner/Lessee/Contractor as A&t for Owner Sig ature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF . L.0 c-4 C COUNTY
Theoir i instru ent was acknowledg before me The forg i mstrume it was ackno' ledg efore me
this 'day of �0 by this of 20by (.
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NamQ o person m=oduced
nt. Name fo person making statement.
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Personally Known Identification Personally Known OR Produced Identification
Type of Identification Type of Iden7fation
Produced Produced
nature of Nota ublic-State of Florida) (Sig ure of Notary Pub c-State of Florida)
Commission No. J ��y� 3 rru lseal SHERILCOOK -I�r/ o`�raue SHERIL COOK
2a1 „e o ) Commission No. a OMMISSION,#'FF 994
W COMMISSION#FF 3
tS. ine w, EXPIRES:June 22,.202
je opo ��uu:ggudd��eetNott��yy NIMS a ThNBu o s
REVIEWS FRONT ZO1 rG SUPEKVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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