HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V Permit Number:
6V
_ .. . _ _ _.. _.. Building Permit Application,,
Planning and Development Services
Building and Code Regulation Division 1yC49aPa OIC
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553., Fax: (772)462-1578 Commercial Residential �'�F
PERMITTYPE:
PROPOSED"IMPROVEMENT,LOCATION
Address: Ll GCLIP-rlCk W, &\1 ?or+ -s -, Lucie,
Property Tax ID#: Q CQ— 0 00 Lot No.
Site Plan Name: 'lir-151 nSM Block No.
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Project Name: T�ISi1f1S�.l
DETAILED.DESCRIPTION OF WORK
A16 Chanz d �. < c (,(l— p o�
-T6 lo -- f
CQNSTROCTIO'N 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:$ 1430.0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name S®Ol'1le �1f. I AS lk\A Name: Ib "Franci sto Ti&t
Address: Company:Qwlf�jAir of ome-ticC.
city:_"fyri- ?�r-f ce State: L Address: 6538 Collins ,9ye- 1
Zip Code: TA11%L Fax: City: Miami State: TFL
Phone No. .1 5 63 Zip Code: 331 UO Fax:
E-Mail: Phone No ftP IS S -7q70
Fill in fee simple Title Holder on next page(if different E-Mail_Q uni i±yw rOfa-Mt?Ci cr,jna m.+i_com
from the Owner listed above) State or County License CA C 133 18-1 -11-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.
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SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION <<
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Na nye: Name:
Address:--_, Address:
City: State: City: / State:
Zip: Phoneme Zip Phone:
FEE SIMPLE TITLE HOLDER: _Not Appl ci able BONDING COMPANY: Not Applicable
Name: �'' Narni— .
Address: Address:
City: City:
Zip: Phone: i Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nn-wor'k 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 ENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF INT D TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y R TICE F COMMENCEMENT."
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Signature of caner/Lessee/C9 tractor as Agent for Owner Sig ature o tractor/Li nse Holder
STATE OF FLORIDA STATE O ORIDA ;� 1
COUNTY OFR COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_'S day of 111"" 20lei by this 17 day of 'J1tn e 20 1qq by
�BDlt/L .rv50nSyt/ �6t�i1C�5Cc� �taZ
Name of person making statiement. Name of person making statement.
Personally Known OR Produced Identification 7z Personally Known OR Produced Identification
Type of Identification Type of Identifi ation'
Pro�ed� P
(Si 'ature o otary ic-Sta f lorid ) e of try u c-St of orida)
Commission No. Seal) Commission No (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
tinaY Pie. STEVEN LEVY r'a" STEVEN LEVY
Notary Public-State of Florida ::���: Notary Public-State of Florida'
4
My Comm.Expires Sep 5,2022 `'.'F�r� My Comm.Expires ep ,
Bonded through National Notary Assn. Bonded through National Notary Assn.
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