HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j� rr,^,
Date: ,5"1 U-1 9 Permit Number:j dO6 Va�J
`• ,OMMEMISIWININNARECEIVED
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COUNTY x 1-. 1,4A1 10 1019
,F iL O R ,( O R --_
Building Permit Application oep
�r�man
Perm�titii�9 to� r
Planning and Development Services S� Coun-Y
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 i
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential !X`
PERMIT TYPE:
PROPOSED IIVIPROVEMENT LOCATION.
Address: 5'2 (e (fowl G55 ( vv "Pl
Property Tax ID#: f410-51
I 1 0�, -" (3 D 2-7- 0 0 0 - 8 Lot N o 2-7
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Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
P-Pp aCc vuSicd duo -e-l-c(rd 5-i- I
5 U Wl f con p S CL V i t 1 a co,..-14d ice)
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that apply:
_echanical _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 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ida VI _ C o A R _ 1 n e Name: LA �I . . - .
_ j 94 I
Address: - 0 VP �• Company:_�.
City: s . t L -C State: e-1 Address: 6 ( a , OF 4-4_
Zip Code: d c �i I Fax: City: _ ` Mme/ / State:
Phone No. �jt-(',rte-- �s(Q,3 ` q tb 1, Zip Code: &2 I Fax:772_5(oq✓gi 13-
E-Mail:
SE-Mail: I Phone N I • 1
- ' 75
Fill in fee simple Title Holder on next page(if different 1 E-Mail Ce6 , ! _ ri Ca /'VI@ 1. Cowl
from the Owner listed above) State or County License b c__6 ij 0,,�3 q
i
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.
i
:SUPPLE MENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: 1 "
City: State: City: State:
Zip: Phone Zip: Phone:
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
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 �' \ i� .. nn STATE OF FLORIDA L 7
COUNTY OF �_UC COUNTY OF
The forgpipg. instrume w acknowledged efore me The forgoing instrument was acknowledged before me
this / y of 20-L-/by this (0 day of ,20 t—j'by
1cxw6 T- lec\s
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification DLR...., Type of IdentificationProduced Produced LI L
elUCUI ' ?AI a
(Signature of Notary Public-State Florida) (Signature of Notary Public-State of of r
�`"""''' ELLEN(SMOGHN Commission No "4P''% ELLEN VF{ a1jN
Commission No. ,tiw`rP�.%
_.° +, .State of Florida-Notary Public ;i. °7�.6tate of Florida-Notary Public
N�%` *_ Commission # GG 270079 E. :E Commission #GG 270079
'%°,il "Ir res oF�ti°:� l, +ii+ sioll C Oros
''' '� i October 22 fj ''+++�"` October 22 20022
REVIEWS -._---:"----7.-7,,--,_ .. _ .,,_.-:-• SOR PLANS VEG�i'�'�*'�— ^BTI --COVE
COUNTERREVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley.2/7/19