HomeMy WebLinkAboutBuilding Permit Application Jun 20 2019 8:08PM HP Fax page 3
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater AZO/l� Permit Number:
f
' Building Permit Application
Planning and DevglopmeatServices,
Building and Code Regulation Division .'
2300 Virginia Avenue,Fort Pierce FL 34982 I,r
Phone: (772)462-5553 Fax: (772)462-1578 Commercial Residential V
PERM IT TYP E: kc
Le .
Address: °l`�`L ..Uvea-1 wo k LN.- ?vvk
Property Tax iO4: 33 Z"t -0 07,q -0 00" Lot No.
Site Plan Name: Block No:
Project Name:
WY, __
Ma
RM t A lu36 &_V N h 9,41 31 11 s4,hNrA leaj- Ei-i 7eik- C
Additional work to be performed under this permit-check all that apply:
u!Mechanical Gas Tank _Gas Piping Shutters Windows/Doors i
_Electric' ,,,_Plumbing ,Sprinklers Generator —Roof Pitch
Total Sq. Ft of Construction: F Sq.Ft.of First Floor:
Cast of Construction:$ 3164.Oo Utilities: Sewer Septic Building Height f
Name �X anl< a*40ir . Name: kkrk WeA&,S
Address: A1,19 &R,,+w%y l- \ LA Company: Xt dAAt 1
city: 1014, ST LVc,2 State:I 1 Address: 541'S -T lI r OOX DY
Zip Code: 314`1$6 Fax: W A City._FO&.
r lw CQ, State-P
Phone No. zip Code: 3N$��. fax: 460" Gb i3
E-Mail: f't i Phone No -1-17,-40-z6 bS
Fill in fee simple Titie Holder on next page(if different E-Mail gV crr iVt 1 dc, &60 Ce nN
from-the Owner listed above) State or County License C,Ar, 1S k5 O t S i
If value of construction is$2500,or more,a RECORDED Notice of Commencement is required.
if value of MVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
Jun 20 2019 8:09PM HP Fax page 4
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DESIGNER/ENGINEER:. j Not-Applicable MORTGAGE COMPANY: _„_.Not Applicable
Name: Name:
Address: Address:
City: State; City: State:
Zip; Phone Zip: Phone: I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: `Not Applicable
Name: Name: j
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. 1
St.Lucie County makes no;representation that is granting apermit will-authorize the permit holder to build the subject structure
which is in conflict with any applicable Horne Owners Association rules,bylaws or and covenants-that may restrict or,prohibit such
structure. Please consuit 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 Godes 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 usesto 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 FINANCIINGw CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1 t
Signature of Owner/Lessee/Contractor as Agent for owner Signature of Contractor/License,Holder
STATE OF FLORIDA ' STATE OF FLORIDA
COUNTY OF St L ti L COUNTY OF_ 7L Z..rrs t:.t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this j2L day of ,2014 by this 1A day of 3-cit ry C,. - .20J by
• E
Name of person making statement. Name of person making statement.
• �'i�Mr1l .
Personally Kno OR�d.iBYltlatio Personally Known derttification
Type of Identifi i i! OwlgGG2fNII0Q T
Produced s Oo�iar2S,ZQ72 P
zmqisl
(Signature of Notary Public-State o `•lorida) (Signature of Notary Public-State. lorida)
Commission No. a 133S"40 (Sea)) Commission No.F /3 3. '9d (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
PATE .
RECEIVED .
DATE
COMPLETED
ev.