HomeMy WebLinkAboutBuilding Permit Application 1 :
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,
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Date: 1 0 I iO\ ;
Permit Number: t,--1.03-- 6 2.c.):_...)
RECEIVED
COUNTY
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Pernlittin
Building Permit Application MstA.YLucie 0 7019 :'
Planning and Development Services
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County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential —2(_-
PERMIT TYPE:
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011'O#OSiED*Pik ONIEMth:17 Ot3ttA11On-:- ",--:-.-1-:-
Address: 63 5 1--1- ---,TT b kill-kJ
Property Tax ID#: i if) C) '5 0 2- - 0i59 - ODD - Z_ Lot No.
Site Plan Name: Block No. 'i
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Project Name:
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CONSTRUCTION INFORMATION
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Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank Gas Piping Shutters Windows/Doors
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_ _ _ _
XElectric _Plumbing _Sprinklers Generator Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 0 0 Utilities: Sewer _Septic Building Height:
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Name 1 IP , ' Li CO i L Name: a_ y
Address: ..SMI ._ t 41 A-A- Company: alailiMigi,e. t
City: p-4- i4tr- l'er_ State: i Address: ( Ca-1 r V t- -
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Zip Code: 5 `4/ Fax: City:.\/t VOState.
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Phone No. il 2-..- 145-7 6 ri Zip Code: Fax: 7-70'C-6.q -9 1 ZS
E-Mail: Phone '11, — Gq - g-i -k5
Fill in fee simple Title Holder on next page(if different E-Mail 4c _.e„ c- I
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from the Owner listed above) State or County License eci_o DO ,,,2..._3 9
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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SUPPLEMENTALCONSTRUCTtON LIEN LAW INFORMATION,;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: I Name:
Address: Address: I
City: I State: City: State:
Zip: Phone Zip: Phone:
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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. !
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work I'
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments. ,I
The following building permit applications are exempt from undergoing a full concurrency review:room additions, I
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
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I "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
of----
Signature of Owner/LesseeContractor as Agent for Owner Signature of C ntractor/
License Holder
STATE OF FLORIDA STATE OF FLORIDA
'" 1 LUCA OF t COUNTY OF
The forgoin.g. instrume w acknowledged efore me The forgoing instrument wasacknowledged before me
this / y of 20 by this (0 day of /14.4r,-- ,20 /by
I CSV) Li? w6 `Tot(0, Ire 03AS
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
Produced 1� 1 Produced ®L
tUtt111 ' F,U
(Signature of Notary Public-State #Florida) (Signature of Notary Public-State of rida)
Commission No. :4�YPo,o ELLEN(18, 1 GHN Commission No oy""d'w ELLEN VP( al)N
▪:° �� S State of Florida-Notary Public ". `�=state of Florida-Notary Public
▪'�� Commission # GG 270079 F' �4 Commission #GG 270079
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°' ` ' October 22 2022..
REVIEWS --:-.------:77.--::` REVIEW22 '0. REVIEWOR PLANS REVIEW V REVIEW REVIEW REVIEW COUNTERW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19
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