HomeMy WebLinkAboutScanned Document_06052019151544All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Permit Number:
Building Permit Application
Commercial Residential j
Address: I 3 O -1 w w 4&4 tcj " ' R21 Lq&
Property Tax lD #: ""Lu ... �30 - 9 -- 00 Z
Lot No.
Site Plan Name:
Block No.
Project Name: tt'.Con1 + Y UCj-1 oYl
L�
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: $ YL 1l0 . Y 0 Utilities: —Sewer —Septic Building Height:
Name Ka kxM Wcwj oY\aLA UQH64(i SSo
Address: VJ 6DV L_PS ,0---'" _5
City: ,om I W_ _ State:
Zip Code: 1SZlDS Fax:
Phone No.C1 0Ll -- 1 S' J-0 Ll (7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
s. ..1. _L_ _A
-Name:
Company:
0
City: �'?O'k t j (A I
State:
Zip Code: 'S''lC`\ (7 Fax:-nL~ 14u -31 I S
Phone No�1�,3--
E-Mail I (kk e 8 ILM'Irb1 Go,
State or County License
__.__ _. __...... .,,..., w, mwi a, a nr%�wn„ru IMUL,ce or Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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: Applicable
Name:
_Not
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."
A of -Own
Signature Owner/ Lessee/Contractor as Agent for e-r
Signature of Contractor icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF t-46-( i-1Y)
COUNTY OF
The forgoing instru ent was acknowledged before me
this day of -J k-4 2011 by
The forgoing instlryment was acknowledg d before me
this S, day of 20_Lj by
`11y'v-,1A1 l ex
"
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign re of Notar "A LIte of FloLWAET.URY
of Notary
k o to of FloMY
COMMISSION # GG 313331164iaRlELURY
Commission No. ,.
=` :: EXPII(IJ�aJyly 16, 2023
:(SignaXte
mmission No.
_*: M'i COMIvIiSSION # GG $13331
o. EXPIRQSkBI*16.2023
c. q, Bonded Thru Notary Public Undarvrrkers
'••,,P,F!:°°' Bonded iluu Notary PubecUn w*kera
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