HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '..:"..11 — Permit Number: I Ct 1-27-
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COUNTY
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-WiffiNiiiiiiiNiiii/Witif— Building Permit Application 144Y 1() Z°19
Permitting DepartMent
Planning and Development Sen/ices
LLICie County
Building and Code Regulation Division St.
2300 Virginia Avenue,Fort Pierce Fl.34982
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential....0e
PERMIT TYPE:
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Address: 63 20 Q.7,_ WA-y
Property Tax ID#: 1 41 0 - 6-D-2-- 0 I 62 -3 - 6 0 6 - 3 Lot No. I (cs 3
Site Plan Name: Block No.
Project Name: '
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tosivslyoctios.,,ip Fp wATION;;73,
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank — _Gas Piping Shutters Windows/Doors
_
—
y Electric Plumbing _Sprinklers —Generator Roof Pitch
_
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ SCOO Utilities: Sewer Septic Building Height: [
OWNER/LESSEE .,P.:.' .._ ,7:: ',,:;1,0-:: ;-,;,:.:3..--':--,-',,,.;:;,.,?.' ...-, toNtitArst-rt*',,i,..
Name 0 1 b in Name: i ., AA. (-5
Address:_6 3 3 OJ-i' ! 4-y Company: AMIN ee= ( C
City: . .----- 1 (Pit I-CC State: ') Addres : / _ _ .4 I .# /
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Zip Code:3 t-FI 4 Cl Fax:: City: '' g. - k ' State:_E/
Phone No. 1g n - g b 67.-q 55-5 Zip Code:, 2---____191Fax:111175
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E-Mail: 1 Phone IA -7-72---6 - 9 775
Fill in fee simple Title Holder on next page(If different E-Mail a5 .P.C., el Villa-t /7.-- 1471"
from the Owner listed above) I State or County License C-6 0,2-e2....0 ',
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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 IIEN LAW INFTIO }
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: � Address:
City: State: City: State: I
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicabl
Name:
I' Name: �
Address: Address:
City: City: I
Zip: Phone: Zip: Phone: I
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 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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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � "USTATE OF FLORID/5k_
COUNTY OF �� CA L. COUNTY OF
The for o�fn�instrume w acknowledged efore me The forgoing instrument was acknowledged before me
this /(ddy of 20 t by this (0 day of ,20 i 'by
Ick) w$ -Tn(ro kLoAS
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification �j Type of Identification I
Produced 11 L 1 Produced ® l..
eJWADCL • ?JJ a
(Signature of Notary Public-Statelorida) (Signature of Notary Public-State of of r
Commission No. 4'i1 , ELLEN(18, 1 GHN "•"', ELLEN V/�(�1�adjN
Commission No .�� �P'.%
: _ a e of Florida-NotaryPublic 'i �u o. a e of Florida-Notary Public
* %='1*= Commission # GG R•1%— Commission #i GG 270079
��.ii•.ac 270079 oua.,,,.s- _ •._•
•mr78 n•u•� October 22 2022 COVE
October 22 C - SOR PLANS VE
REVIEWS _.�:-..=.e.�.:...-. ,..:,•: .. _.,,-__.,.
COUNTER' REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE '
I
RECEIVED
DATE
COMPLETED
ley.2/7/19