HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ja (1 (,,�I
Date: i� /� Permit Number: [ l v 5 'U'
RECEIVED
F L ® R 1 Q R. "-
Building Permit ApplicationMAy 02 2019
Planning and Development Services
Building and Code Regulation Division permitting Department !I
St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential lC
PERMIT TYPE:
PROPOSED IMPROVEMC 'OCATl®Ng -
Address: G c 39 5('c r a Aue.
Property Tax ID#: l' n(0-57 " I T )DoIG Lot No.
Site Plan Name: Block No.
Project Name:
DgirAILED.DE--€RIPTIONO[P MEM
/05„kJ( r)e t�J pi,pl -5-ififr s j/S ct^. 0,4 here-A, p roc-4
1610 OC) i v -Lk- v1
CO ,TRUCTION EINFOR Al {MND ,"
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: $ 4,O0:2-7- 06 Utilities: Sewer Septic Building Height:
i
OW SER/LEM a. CONT°AC OR°
Name tkeVlY\- 1�f C+ 6f, Ct,0 rli„a I ALL L Enje{ Name: c-SGs e �c,rca Ge-0 rf 2uld ce.-.
Address: :Y 3 9 pr% 4k: Company: 1 : •'u 1 l:N C
City:rc1r'F pt a r,— State: Address: t(03 (-ILA., st,r
Zip Code:31A5I Fax: City: 1 IL, : L State: 1{%
Phone No. --t0— 7 if,-- /709Zip Code: '3 LP-35) Fax:
E-Mail: Phone No
Fill in fee'simple Title Holderon next page(.if different E-Mail Clcj. a d rt c O ,1 .Co V).`
from the Owner listed. above) - , - State or County License 014-( /S 14 s,90/ (led" VE
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.
41P°PL@MII ,-CONST.RUCTIQ UM[ 'IINFQRMATIONo 'H,-..
va
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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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
TO YMOUR PROPERTY. IN 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."
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nature .�,-awner/Lessee/Contractor as Agent for Owner gp.ture of C`vractor/License Holder
STATE OF COUNTY OF FLORIDA 54_ ut CU_ COUNTY OF STATE OF FLORIDA Cl j
The for oing instrumentwa acknowledged before me The forgoing instrument was acknowledged before me
this day of , 20 /7by this iceday of ( , 20J by
7n5‹._ Me-0t_.2_,, Sox mer\d .
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 PL 0 L Produced FL I
Cil 0i ��/' ..
(Signature of N.,,a.. =,.:....f:..,-' .aa •' (Signature of:lotary Public-Stat of Florida)
'"Vf�,, ELLEN VAUGHN
,� °,.. State of Florid ry Public i �� ��
Commission NO. �a%;\�= , � Commission 1��Se::Ss• E EN v 1:. 4'—`
_+ff ", om ission 270079 y
IIii''.°�' My Commission Expires =, n/ f`- ate of Florida.Notar
�eiriO''` oa1IFL,r. ` Commission ; Y Public R
October 27. 907 _ p. d,p C
�,,,,,,,o 0 ommIssion Expi es
REVIEWS FRONT ZONING SUPERVISOR PLANS ----7—.-..------4.. �- '@22 M i VGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIE� Y.–......" VIEW
DATE
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