HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number: O 5 '
RECEIVED I
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Building Permit Applicatio
ST. Lucie County, PermM
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMITTYPE cx L C nr
1
Address: _goon k1 can 4bF-,4r-+ -L105 CS1 (, ..8,,.4/e,o,z Q f-Y C,C.,b El-
Property Tax 1D#: -7 1)1 n n � (7���=C'j Lot No.
Site Plan Name: Block No.
Project Name:
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C4NSTRUCTIQIV l I!!�F()RMAT!PN
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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:
, l� Sq. Ft.of First Floor:
Cost of Construction:$ ,�'1�, 06 Utilities: —Sewer Septic Building Height:
A s C 4.,c, c n:. d -� tx �, t �i [,
;t3WNR rLESSEE CONTRACTIaR
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Name_ C�t;jl .Y CS Gu'?!� Name:j Ccs- oyl C)I bf'(Son
Address:-79i'f-7 t1Uft-.1-h Company: )I E 'i ' r f i'- ji t'l ifJ1'1 Y�Q�
City:1 ,IGc' G at" 1 State: fL Address: 1,50 Sf f�f ,-P--- 8-vif, LSfe-- 1-=`I'
Zip Code: '5a> JL4(0-7 Fax: City: State:
Phone No. J `2-AW Zip Code: i-t'q 2, Fax:
E-Mail: }'lett �, COM Phone No -} -- �1 `1 S
Fill in fee simple Title Voider on next page(if different E-Mail a-e r 11h c
from the Owner listed above) State or County License /m q. rf ('0
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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DESIGNER/ENGINEER:: i 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 tti 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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF,COMMENCEMENT MUST BE RECORDED AND
POSTED E JOB SriE BEFORE THE FIRST INSPECTION. IF YOU JWITND TO OBTAIN FINANCING, CONSULT
WITH YOUR L NDER OR AN ATTORNEY BEFORE RECORDING YOUR-i 0"In E OF COMMENCEMENT.”
Si natur wner Lessee/Contractor as Agent for Owner ig ture Con or/Llcense Holder
STATE OF FLORIDA STATE OF FLORi
COUNTY OF Ci G=� 111 COUNTY OF G2.k=i 1 t1
The forgoing instrurrWnt was a nowledged before me The forgoing instrument was acknowledged before me
this day of 01 Ll - ,2043 by this -9,*7-7 day of { S�- ,201-q by
)a".�okl 0ulbe-r'son r 3 a�,0n (1,C
Name of person mak
ing statement. Name of person making statement.
Personally Known N_ OR Produced Identification Personally Known✓`_ OR Produced Identification
Type of identification Type of Identification
Produced Produced
(Signature of Notary Public- Signature of Nota
Notary PubsiC State of Fioriaa g Notary Pt1bli
+ ichelle Thomas Ngtary Public Suis of Florida
Commission No. �l}ymis�sion GG 490769 mmission No. �� +P � MIC, ����orrttas
tstt� EXpites 03,+2'312022 a 1 Mi*lxion GG 190759
1 S � ( S � Expires 0312312022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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