HomeMy WebLinkAboutBuilding Permit Applicaiton ,
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1(a.1iq Permit Number: Q5 t)2g5
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Iii t ''M RECEIVEb
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Building Permit Application MAY 1 3 1019
Planning and Development Services permitting Department I
Building and Code Regulation Division St. Lucie County I
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential / i
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 310'1- I(o01C, •(LVD . i
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Property Tax ID#: - 2o5-cit 1 I r ar)' a_ Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit—check all;hat apply:
EHVAC (�' Plumbing Gas Tank Gas Piping —
Shutters a Windows/Doors I
El Electric L_ Lj Sprinklers I' n
Generator l 1 Roof (Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:n
Cost of Construction:$ � c7 0 • Utilities: Sewer I (Septic Building Height:
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Name LAND I RUS I 3169 i20PIC, ( L\1i Name: _.h"Arfle.3 C. H0I--1,d(, � �` .
Address: °1 IrbC' N Company:A( 1AI -IcC,-1-ri :e \ C.,6' '1 trod '-4\C--
City:
-City: b 1..a.PH 1 ? J CH State:F I, Address: 1 oI U V\( l'i Ii)lJ)K\f 'Q. ,
Zip Code: 3:-A)41-1 Fax: City: PV. 17I .1.e.._:a State:
Phone No. Zip Code: 3153 Fax: `77P..-1-11.0 I- n
E-Mail: Phone No. i-i;- 1-160- w,./) .Fill in fee simple Title Holder on next page(if different E-Mail: ..\CAY4he3fini1I.IiiCAp al.l'fm
from the Owner listed above) State or County License: \d1'a301`1;5��) i
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 1
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( 'I DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State: _
Zip: Phone Zip: Phone: 1
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:
Address: I
City: City:
, Zips 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 1
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.
Niki I
Signa �r-e, Owner/Lessee/Con ractor as Agent for Owner Signet a d€Contractor/License ol.-r
STATE OF FLORIDA STATE OFT-WRIT A /
COUNTY OF -91—U1 Q,), -.___ - COUNTY OF l CC '' C_C 1
The forgoing instrument was acknowledgedAefore me The for oing instrument was acknowledged before me ,
this day of 201/ay this / ay of jmA--,----,_21 by 1
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 r2 DL.-~ Produced P-C. '
(Signature of Notary Pu. State of Florida) (Signature of Notary Public-State of Florida)
Commission No.' LLEN MGHN Commission No.
,,.iiY 1! ELLEN ` HN
i'{tY PUB 1PH d i
=o ��;State of Florida-Notary Public =roV_��^State of Florida-Notary Public
''"� + Commission #GG 270079 inn *s
c Commission #GG 270079
My Commission Expires,
4ini o``� October 22, 2022•. I " ' October 22 022,:_
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REVIEWS ..,_ v . OR PLANS VEG _ --.._ _ - . VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
RECEIVED
DATE I
COMPLETED
Rev. 8/2/17
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