HomeMy WebLinkAboutBuilding Permit Application LQLr► L i��+� �' -<TuA C. IrC..o . b(L4 .
All APPLICA E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: � 7—
RECEIVED
- - Building Permit Applicatio JUL 12 2019
Planning and Development Services ST. LUCie
Building and Code Regulation Division County, Permittin
2300 Virginia Avenue,Fort Pierce FL 34992
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
P.ROPOSED'IM"PROVE NIENT LOCATION:
Address: SZ3 LDuF�-a-Ant- P!ujr -r"LL�r F—r- if fep_c.�
PropertyTax ID#: 2-32,3- 701 - 6)6L1-(,-000_ V Lot No. /3
Site Plan Name: Block No. 4--
Project Name:
DETAILED-DESCRIPTION OF WORK:
o Li w 11-14 Pg-GT L(N
CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shuttersindows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Constructir^:. -- Sq.Ft.of First Floor:
Cost of Construction:$_ t61_006_ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: ;` CONTRACTOR.- ,
Name 164alI A-1 60CC-6 A Name: -/Zb /J 14`lour
Address: $'-t7-3 L-c+N�Saz^^��n���" Company:
City: �_ 'P/L-i�Gl� State:PL Address: *171 SG- /4 6&Y-'T L&Do 2�
Zip Code: .3'fSc/Lr Fax: City: ST"4_YL__r State:/=L-
Phone No. Zip Code:3 Y 11-_? Fax:
E-Mail: Phone No 215- %Coq-u-
Fill
Fill in fee simple Title Holder on next page(if different E-Mail t2C.N 6u 1`'' t Q#7l",W L.6a
from the Owner listed above) State or County License
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.
SUPPLEIVIEiVTAL CO.NSTRUCTION_LIEN LAW(NFORMATIOIV':
. .;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 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 thepermit 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:, OUR FAILURE TO RECORD A NOTICE OF COMMENCE ENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPR EMENTS TO YOUR PROPERTY. A NOTICE OF :OMnENCEMENT MUST BE RECORDED AND
POSTED ON THE OB SITE BEFORE THE FIRST INSPECTION. I U IN D TO OBTAIN FINANCING, CONSULT
WITH Y R N R OR AN ATTORNEY BEFORE RECORDING Y4 fftgE OF COMMENCEMENT.-
/V
Sign t f er/Le a/Contractor as Agent for Owner SI atur f Contractor/License Holder
STACJ
OUTNTY OF FLORIDAE OF 'J� f . - �� COUNTY OF STATE OF FLORIDA S ! , ,
ed
The forgoing instrument was acknoo-wlediged before me The f r oing instrument wa acknolwledged before me
thisqday of 20 by this day of �' 20 by
M Rum RM
Name of person making statement. Name of person making statement.--z
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ��f Produced r--
(Signa t �r Pu lic-State of Florida) (Signa re of Notary Public-State d0loricla)
` ,�" ELLEN VA(OQJN ",
Comm i i �e% Comm ip� Jam. FI i r�� HN
orida-Notary Public =Stand-NU
;y Commission #GG 270079
•,,oF� y Commis91on Ex ireS ooF�oQ`O: My�C G 27 079
REVI 9st 98 UPE ISOR PLA eG TATIONOo Skjwax i6A ROVE
C W REVIE 022 R IEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7 19