HomeMy WebLinkAbout1904-0643 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q(�
Date: 4'c��9 "�� Permit Number: V oq' -ow
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Building Permit Application
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
PERMIT TYPE: � � C,�a,��e -�}�� �kytSL Fcr C�k�1
PROPOSED IMPROVEMENT LOCATION:
Address: 9 Q0 5 (Q Ivy A 1 A
Property Tax ID#: (4-Q ( • Cxr)c�—GdG" 1 Lot No.
Site Plan Name: y 0 C<j L,-C— Block No.
Project Name:
bETAILED-DESCRIPTION OF-WORK:
CQJNSkCAk '} k13 1�-A Su Skf" l3 W f'�t✓(��
CONSTRUCTION,]NFORMATION:
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:$ a d Utilities: —Sewer —Septic Building Height:
:OWNER/LESSEE: , "CONTRACTOR: n
Name 1p r' c ( t (,L-c Name: T (-
Address: r`��Ci(� �V� S A,IJC)-S C-r Company: ^d L—` [AQGA L 6T '
City: �f Q M State: FC Address: QSS4 44)�e
Zip Code: Fax: City: p�Q �c2 State: F'Ac
Phone No. Zip Code: Fax:
E-Mail:•, Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Ci�� l.� CCM,
from the Owner listed above) State or County Licensee LQ�
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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SUPPLEMENTAL:CONSTRUCTION•.LI,EN LAW IN OIRMATION':
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
i Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
I Name: ' Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
jOWNER/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
WIT YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOMIYOTICE OF COMMENCEMENT."
L A
SSiTgAna aof Owner/Lessee/Contras orbs-Ag _f= ner Signa Contractor/License Ho er
B OF FLORIDA FLORIDA COUNTY OF COUNTY OF a pQ ate.
The forgoing instru nt was acknowledge before me The forgoing instrument was acknowledged before me
this��yday of 20 by this day of I�A'l�t,,� 20B by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ign ure fKNitary Public-' State o orida) gnature of N of Florida)
t�drP� LASHAHNAING 4
i Commission No. ;fw6�•., °=: � �MING
LAS I G Commission No. MMISSIO 75060
MYCOMMISSION# MING ;± �• EXPIRES:Det�mber410,2022
-FOF F o? mber*10,2022 buoyru te eWters
REVIEWS FR PLANS VEGETATION SEA TURTLE OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.