HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DaterPermit Number: VW\- (3y3 0
RECEIVED
- Building Permit ApplicatioLST--!1u=Jjt-fe'q00t-Y,
SEt� -,3, 19
Planning and Development Services PermlaingBuilding and Code Regulation Division - ---
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1z
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:- 1-7 19,0 14(>,m meek L_h
Property Tax ID#: 3A I I Lot No.�_
Site Plan Name: ,, 11 Block No.
Project Name: C t i Q,v1 ACrS
DETAILED DESCRIPTION OF WORK:,
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit–check all that apply:
Mechanical Gas Tank _Gas Piping —Shutters Windows/Doors
_Electric V Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: ooZy(} Sq. Ft.of First Floor:
Cost of Construction: o&O0, Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Eu" 'Name:Co cJNr d 9,o( e-
Address:-*?Q.3 t}p�( r i o� dt *� $�� Company: Ile AIC. - c.
City: vrFa,n �Q O.CG, s State:,. Address:4g6[�`:S`6o" bo:rfph
Zip Code:3,3 3 Fax City:(or-� 5� L( .'-J e State: FC.
Phone No5rol"".�67 o '�G� ' Zip Code 3895'3 -
E-Mail: ;- . .. _,;; -.' ��� ,. '�- �
Phone No 641' l
Fill In fee simple Title Holder on next page{if different E-Mail C-0viJ&y)8 ro (a a ,C 0 Y
from the Owner listed above) State or County License CRC I R ( 6(to
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:
Address: Address:
City: State: City: State:
Zip: Phone Zip: 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.
1 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&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."
Si toe df Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLO A
COUNTY OF= �r� COUNTY
;'May
instr ac awledged fore me T forg instr n w s acknowledge efore me
of 20fTy t ' da of . 2Qby
Nam of person making statement. Name of person maki�n sstta't'ment.
Personally Known •` OR Produced Identification Personally Known (/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature ota u ic-State of Florida) ".4 (Sign atur' Nary Public-State of Florida)
� M. G+ +Frees
Commission No."' NOT OM416 Commission No. NOTARY PURM9
STATE OF FLORIDA STATE OF FLORI
REVIEWS FR EAMI C;412P*RVISOR PLANS VEGETA IftYPa ANGROVE
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW ,REVIEW
DATE
RECEIVED
DATE
-COMPLETED .
ev.2/7/19