HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ..5- LO q Permit Number: I c1 0
RECEIVED
COUNTY MAY 10 2019
.0 R I MI A ---—
IMMINNEMENONIMEMOW Building Permit Application
Department
St.Lucie Count,/
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 y
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 52-0 Cavipct5.5 c PIQ Cc_
Property Tax ID#: /410 - 5 02-- DOM- - boc)- 0 Lot No. 34
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
Cfl9 ner' Vu c5+-CJ () LA4- i1cr LecJ Csq-eL I
c_ aJvirs / oca-f-t
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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
Electric Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 6 0 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: , --I CONTRACTOR:
Namenr154-aftcc e.( -Q
, Name:
Address: D 61/14e005 (ô 'c-- ("/QC-c Company:4.! le C.- v
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City: rw-c, State: F Address:/ i grktruyt- 1 -kc iJy
Zip Code: Fax: City:Vejt0 r6.e.oC State: fE/
Phone No. 1 I g —7-C) I 31 54 Zip Code:- 2...c Fax:772-5.0-q 77-5
E-Mail: Phone N 7 7 - 6-6,6? q 7-K5
Fill in fee simple Title Holder on next page(if different E-Mail c45--ee_a-114C ,Ii/Lac I (ow?
from the Owner listed above) State or County License 0
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 CONSTR77, UCTION LIEN LAW INFORMATION ` 4
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State:_ City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: I'
Address: Address: II
City: City:
Zip: Phone: Zip: Phone:
II
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. it
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 ., nn �, , STATE OF FLORIDA 1 I
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COUNTY OF l LUC L COUNTY OF JJ
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The for of instrume w acknowledged efore me The forgoing instrument was acknowledged before me
this / y of 20by this (0:) day of M4 ,20 / by
7 GX\ W6 Tn(n t ec\s
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 0 1 v Produced ®L
tUUlt)1Fli a I�
(Signature of Notary Public-State Florida) (Signature of Notary Public-State of of r
"'Vd" (IS@dU1GHN ELLEN V/Oa�)N
Commission No.f .o i,, ELLEN Commission No . rn
▪�° a, 1 State of Florida-Notary Public .11111.° State of Florida-Notary Public
��▪ %� *_ Commission # GG 270079 Commission #GG 270079
<-0,. , ' M C s. i P�;' vty Cummissior, E plres
,, ,i,Ho,, ✓Commission 22 xpfrb9 ''a$„*,�°�`� October 22 20 2,..
October 22 .I�_
REVIEWS = SOR PLANS VEG'�I'`T'Gi`' SEA TI ROVE
COUNTER' REVIEW -� REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 1
DATE
COMPLETED
'tev. 2/7/19
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