HomeMy WebLinkAboutBuildling Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,sem C:�
Date: ts131 001°1 Permit Number: `V 1
RECEIVBE l " & lU
toti t JUN 0 3 10
e , L. 19
__._.. ' Building Permit Applicatio ,ittin
� 9 Depart
Planning and Development Services St. Lucie Countyent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial v/ Residential
PERMIT TYPE:
::PROPOSED fMRROVEMENzT LOCATIOiN
Address: D � '...
LJ — 5, US ou
y •1*1
Property Tax ID#: 341 -501 - I jO3 ac0- `1 Lot No.
Site Plan Name: Block No. 3'
Project Name:
DETAILED DES:CRIPTION'OF WORK - , ;1'
>ar�r1�n ao-C\i -tom 'fo e_);C3+1 cl ho( e —Po
ter, o h cm cum p
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:$ I, 100.°° Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR._
Name ?C11i11 RareCen-k25' l `� Name: domes E✓ , Hrx-1-I,do1.
Address: 15aRFT (�lr IC(�PY Land rp Dr, Company: HCA-FU IG E\ d lea) l=( t-raC1t S
City: �l,.5 GC_I') U Stat�1 pi , Address: 1 b ID - L M idu12,Nf 'R 1
Zip Code: 3)-1q 59 Fax: City: t'I�'rub State:F)
Phone No. Zip Code: 3�1�$2, Fax: Lib)-4(0%5
E-Mail: Phone No 4.0 1- S3(9,8
Fill in fee simple Title Holder on next page ( if different E-Mail jaryle,Sfi'1G1T1CZE 00( . earn
from the Owner listed above) State or County License CC 1300 1/12,/-4
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 CONSTRUCTION: LIEN LAW INFORMATION: , . '
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: I
City: City: I
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.
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."
Signat `Owner/Lessee/Contractor as Agent for Owner Signat nif Contractor/Licen Holder
STATE OF FLORIDA __ uuk_e_f_.,____ STATE OF FLORIDA c•
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged befpre me The fqrgoing instrument was acknowledged before me
this .3 day of 9/1J , 20 ,15-y this day of _ ,20 /lby '
011A ad - ha .4.1" -
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification F r1 Type of Identification
Produced �__ Produced L
S .. af ------_____________
(Signature of s t„, , '...!;,- ,,....,,.d::::_ ..11.,
(Signature of Notary P. kik ':: of FIr1agN VAUGHN
,,,1111,,,
ELLEN VAUGHN ;y II;, e-o_State of Florida-Notary Public
,PYP(,/, I 7�1i11J, Commi l0l#GG 270079
Commissi �% State of Florida-Not blic Commission No. t�1y5 §
=. I!"��*_ Commisston #GG
�9 Y Co s ion Expires
��;f 1111��
�s1tll Qom: My Commission Expires ..� October 22, 2022
Snn�Z Oct.•er 22 2022 _ — ,_
REVIEW RONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED 1 -
lev.2/7/19
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