HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 -17 Permit Number: I lVUJ
x`71=-' � :-
RECEIVED
Cct.i I rir"Y q
F L CO Ft I D L -M- O��
Building Permit Applicator L
Planning and Development Services perrpittin9 o ou gent
Building and Code Regulation Division st.Lucle
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial _ Residential
PERMIT TYPE:
PROPOSED IMPRCAMMur LOiCA ION:. ._
Address: gre % / S �d A) eNie- /. Itat & fa Vg
Property Tax ID#: 2 i. (9--(Q1 . (p0_30f 0O0 A Lot NO3 1
Site Plan Name: "/I I A — 9M� f Block No. cam'
Project Name: Gt. GI
1312TAILN DE CRIPTION di WORK? ° .
�lj27tl . tJ /
21/V121_ -
MAI U� iii 1• 0
. J 6'
CONSTRUCTION INFORMATIONg
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank —Gas Piping _Shutters •� _Windows/Doors
Electric _Plumbing I _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: ( q`'(� Sq. Ft. of First Floor:
Cost of Construction:$ 9 r1)`-' Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE° CONTRACTiOR:
Name gitirit Name: Ai, . .,
Address. i I `�...._ '\�1�:`/\ Company: Ii 1'�/1�_ 6 !' !` 0,
City: "fir,; '' State. r Addres. Lir 5! g1 .4.4
ZipCode: �j Fax City. ir :. State: Aa'
Phone;No. S6w �' `Lf;`� Zip Code: a- try Fax: F L
E-Mail: Phone No,, /i ��J,,��"-�or
Fill in fee simple Title Holder on next page(if different E-Mail ,lAl!Nl 11 fere L M � ��
from the Owner listed above) State or Co' my License iv-01 dr
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.
SU,D.PLAML CUNSTRUCTIDN OM a�'�Jn OG ( o RMATIONg, .
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:
Address: • / Address:
City: `� City: /
Zip: hone: 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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject 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
WIT� R LEND N ATTORNEY BEFORE RECORDING Y R NOTIC OMMENCEMENT."
Sig ture of 0 er/ essee/ ontract• as Agent for Owner Si nature of Contr.ctor/Li ense ilder
STATE OFF ORID i STATE OF FLIP Cont.
COUNTY OF S i'ak__e-,L. COUNTY OF _
The forgoing instrument was acknowledgedAfore me The forgoing instrument was acknowledge efore me
this of 20 (fy this7_4ay of ,20 by
cAre-X
Name of person making Cement. Name of person making sta ement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification
n7 Type of Identification /
Produced f�--( 1✓ . Produced P( � p(..-7
r -
1
c�laskaa 1i�&ka5e
(Signature cy�l3�i (Signature of No � ... _,�.„�•• 10,r10,)
s '°8�,. ELLEN VAUGHN "�a,. ELLEN V_ w-
Commission Via ,\o;State of Florida-N {gl ublic c; HN
�( P Commission No. •
r:A.N.A,
/••\ _State of Florid y Public
_* �*c' ommission # GG 270079 � �*= Commission #"'Ilio�;c My Commission ExpiresIjlPs`c GG 270079
,,orr� � My Commission
�___ O lobo_23,_ 14. �_ ,,to ,.°"`` xpiros
October 22, 2.22 I.
REVIEWS FRONT ZONING^ SUPERVISOR PLANS VEGETATIO ' ► VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
7ev. 2/7/19