HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date5 `0-161. Permit Number: t -1A-)L...) U({1)5 kj
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monassimswaseir Building Permit Application
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Planning and Development Services ;
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential—X--
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION. 0 , ' ' '
Address: 5 3 d--(--- 'Tt.. 6 (Aht-y
Property Tax ID#: 141 () -5 02, - 0 1 tog"- 000 - 0 Lot No. i 6,4-
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
Mechanical Gas Tank Gas Piping Shutters Windows/Doors
_ _
4_ _ ,
Electric Plumbing _Sprinklers _Generator Roof Pitch /
_
Total Sq. Ft of Construction: c'0 0 Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: , : CONTRACTOR , =
Name _ _ , jj A J--- Mt l'C 1r Name: ,_ j 1--(,,AA1IS
Address: Miff- 4
IA. Company: 'a, I- 0, 4-tri c
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City: Milir ' V - State: J Address:1 VIrfa , )5LA.
Zip Code: Of 0 Fax: City: ''A ,... OLL i
State: i
Phone No. —I, Ilo - °I, t 2--14cr'2_ Zip Code: ,-' 2-€6 g Fax:172--5-0-'q11.5
E-Mail: Phone No 'I 7g.-- 6Ze..q - 9-7 1 5 i
Fill in fee simple Title Holder on next page(if different E-Mail MS 1-4,-140C4fri;r_0,-- 9 ma i i t C oki
from the Owner listed above) State or County Licenseiiiil 0.-- 660
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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 CONSTRUCT ION LIEN LAW iNFORMATION�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: i
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: . _Not Applicabl
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.
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 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 LU
STATE OF FLORID/5"k_ ' q
COUNTY OF 5V 1 ULA 1- COUNTY OF J�
The forgoim instrume w acknowledged�iefore me The for oing instrument wa acknowledged before me
this / y of � 20_G-7by this (c day of /14..49- ,20 / by
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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 Q,
Produced Produced
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(Signature of Notary Public-State Florida) (Signature of Notary Public-State of r
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,��Y°� t �GHN ELLEN VA( IjN
Commission No. �~w� U'.�, ELLEN Commission Na �+���r'a���i
., , ,State of Florida-Notary Public `:d :state of Florida-Notary Public
9� :Commission#GG 270079 1 =*P''"Iti *= Commission#OG 270079
;,°• a r:s �,' 4,„.� My Commission E pkos
October 22 .p R '.?„*„o _ October 22 20 2
REVIEWS COUNTER REVIEW a. REVIEWO REVIEW PLANS VE REVIEW 1�w REVIEWkOVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
1ev.2/7/19