HomeMy WebLinkAboutBuilding Permit Application 11
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V`
Date: c---( -5---1 Permit Number: (Q s- V j3
:mimpiNu
; RECEIVED
COUNTYM # MAY 13 In
--- _.. . _.. Building Permit Application DeF,nl•rrt`•4;"''
Planning and Development Services per SttLn9 e Count\
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION,. _ ,,. ,
Address: 53/9 vi k-4-- W//A-1/
Property Tax ID#: 141 G 5 o2- - 0153 - 000. - 6 Lot No. j 53
Site Plan Name: Block No. i
Project Name:
DETAILED DESCRIPTION OF WORK
,/ ) la cc Vu :S�-f-Ce 6 (44-- wie-kv p-Lei t s
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply: 1
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
1-Electric _Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq.Sq. Ft.of First Floor:
Cost of Construction:$ 5 V 0 Utilities: _Sewer _Septic Building Height:
.OWNER/LESSEE >`, , , CONTRACTOR
IName ' . , VL'r +- Name: uU,„
Address: I ' . ` Company: �tiS " -l.e_c-1- t C
City: ( lc State: a Address 3 i "V L .14 'y
Zip Code:_ r Y
Fax: City: Vi_,l4J / '' / .� State: ' r/"
Phone No. 5(01— 72 L-4-O I( b Zip Code:'52..A, g. Fax:'772 6( ' g775
E-Mail: Phone7 o �� J�.. .,5%— g �7s
Fill in fee simple Title Holder on next page(if different E-MailO( Q(J I �� V)/ac 1 ,
from the Owner listed above) State or County License 0 6 O0 ;3
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.
SUPPLEIVIENTALCONSTRUCTION LIEN LAW}INFORMATION 1
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State: II
Zip: Phone Zip: Phone: II
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 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. 1
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work 1
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, 1
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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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAi , n STATE OF FLORID&T�ux
I
COUNTY OF LUC1 � COUNTY OF CLL
I
The forgo�tpg instrume w acknowledged� efore me The forgoing instrument was acknowledged before me
this / (ay of 20 L/by this (ob day of ,20 iby
7 0\1 Li? 03$ Totk) 1e0 ,S
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificationr �j Type of Identification 1
Produced 1) l.. 1 Produced ®l.
selUtiik, ' Fl1 cE
(Signature of Notary Public-State Florida) (Signature of Notary Public-State of of r
"" "' ELLEN(SWG Commission No V i"#,, ELLEN VP(�I�aMjN
Commission No.� :�w`YP�r.^S ����"'
g: i -_State of Florida-Notary Public i°/Pay 4Abtate of Florida-Notary Public
__� •_ Commission #GG 270079 iP'` Commission # GG 270079
4404,,,v,,,, • • •• r:s %; '1 0' My Coinniission C giros
""� October 22 ,D ''+'�� October 22 2022
REVIEWS - = .: _.. • --..r::—:=-:•-•'SOR PLANS VE OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Zev.2/7/19 •