HomeMy WebLinkAboutBuilding Permit Application l6
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I "t,G� Permit Number:
Building Permit Application � �� �
' Planning and Development Services ®1�
Building and Code Regulation Division ��L �•�' artme��
2300 Virginia Avenue,Fort Pierce FL 34982 peP qty
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResidentialpPr
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PERMIT TYPE: 6-C-1-B, I G
PROPOSED IMPROVEMENT LOCATION:
Address:1 ( �� AI.l� �1T'�IS�J ( l— I ml
Property Tax ID#: 111y.) 6�—9Y Odd //'1C��®�� Lot No._(
Site Plan Name: /� ��(3/Z j� ��jTl��� �T� ro���.0 1'1)45- Block No.
Project.Name:
DETAILED DESCRIPTION OF WORK:
G �1 ® 9i (`c.c7i1 (�L
Fk4 CHPWer B(n 10, 14Q m e cxo ne
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:$ �D�f ® ® Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ® I Name: J-ba&f 5
Address: ! Rl(9� ;C 033 �/I� Company: A+ ELF=eag I C/4-0
City: C--kii— Stater Address: na-C7) MAKI AV e.-
Zip Code: _ Fax: City: ft l 1 5'�'G°� Lai e Stater,
Phone No. Q 6.1 7 — 7 W6 Zip Code:J qVq Fax:—
E-Mail: Phone No.22A 1
Fill in fee simple Title Holder on next page(if different E-Mail Ah A21 '6D W\
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:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE.COMPANY: _Not Applicable
Name: Name: l
Address: Addre
City: State: City: - tate:
Zip: Phone Zi Phone:
FEE SIMPLE TITLE HOLDER: _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 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 QIR AN ATTORNEY EFORE RECORDING OUR NOTICE OFC MMENC ENT"
Sign u e of Owner/Lessee/Cont actor as Agent for Ownerign re f Contractor/License Holder
STATE OF FLORIDA �-- I ii c STATE OF FLORIDA S �i
COUNTY OF J�_ 1�� f,1 C COUNTY OF
The forgoing instrument w c no ledged before me The forgoi�n nstrument was acknowledge efore me
this&,�21' ay of 20��by this_(2=�@ay of 20 by
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 (, �7 Produced
(Signature of Notary (Signature of "Y I' St Af'�
�tiPpY PVB/'�' ELLEN VAUGHN e of Florida HN
?a� State of <� Commissio Notar�yPuhlic
Commission No. �A I/ a Notary Public Commission �' s�oQP�� . #G '� b79
CommtM# GG 270079 missio
My Commission o Expires lgiil®ggF gra , x res-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.2-171-19