HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '5\C0\ \d\, Permit Number:
77,
RECEIVED
`` .�w MAY 0 6 2019
Building Permit ADIAlcati n
Planning and Development Services _ ST. Lucie Ceentyf ge.rmltting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:A/c
RROPOSED IMPROVEMENT LOCATION
Address: 21/0 gov4 2,814-, S-t >o_g-+ P<- 4 c,
Property Tax ID#: ay a`� O a o Otl 5 Oc'�' S Lot No.
Site Plan Name: Block No.
Project Name:
DETAtLED DESCRtPTeON OF WORK
10,E
CONSTRUCTION INFORMATION ' ` � ` t
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:$ T ` ZQ Utilities: —Sewer —Septic Building Height:
_OWNER/LESSEE ` CONTRACTOR
..awy. ,.-.__..,. ...:L .ti.........._...c,u> vcwwe..w-. - �.......�'..,.w,».....c.u......._-..,.�.�......_.. ._....._ .. ..�.fuiv.ie...._s..i...o.u�.Jr>�.�.m..w........,,`5......�_.... ..,.,..,..no.?.3,.._-..s.-.. �:':b.:..:..,..�....
Name ndskick1)4hep- Name: ceillt
Address: ZZId Sate-Vt Company:-C_a.i/rs Et �c-y_ 64100 41I-L Co Ad
City: PGrc.`r State: FL Address/10(o2_0 QJ fog
Zip Code: 3y58 j Fax: City: ?SCI StateEL,
riwiic ivy.7-7z 9l c( 331 , 7_iN Cuuc."3`b —) Fax.
E-Mail: Phone No_7 7 Z-370 01,'
FII in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C 64C-to/6'7 1 Z
it value or conszrucuon fs m3w or more,a Kr_LuKutu ivouce of wmmencerd n[rsrEcjui Cu.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIMLIEN.LAW INFORMATION.
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 thepermit 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 erantine 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
Pa5TM rev TSSC firm CSR recon M'RSC CSnGT swcnCf TM!!_ w VA/1 /wTClun TA ADT/ NN CSMARWEAW f name/!T
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
ign re w r/Lessee/Contractor as Agent for Owner -nature of ctor/License Holder
STATE OF FLOHIpA STATE OF FLURaDA
COUNTY OF COUNTY OF S A-y c V'k
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledge before me
this G day of may 20)°_ by this Q? day of 11%2sy 26 ,,• by
C ZJCqday Z o
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 V L— Produced �0 L
(Signature of Nota ublic-State of Florida) �s (Signatureg blic- 12023
���""•`` '" l :r°'....cf,: MY COMM, 2020
:► R December l6, ets
Commission No.C%4 ' MAR1EGNc` 1' -*°
A #GG0220�3 �' Commission ftcT o a oleryPublic
,otY P�J�•i ,' iiN,••
'= MY COMM4SStON ber 16 2020
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