HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �j
L
Date:I.= 1��_�1 Permit Number: / �®
S-�' -_ J�`C` QED
Co Ty
�. SEC
- Building Permit Application to 1g IO
Building and Development Services Code Regulation Division permlttln9 a noun"�t
9 9 St, ucle
2300 Virginia Avenue,Fort Pierce FL 34982
UN
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION.=
Address:ano ero k9-e- Av, ,0.1, CL
Property Tax ID#: IMn 10k 1113-Imo-Y Lot No.�
Site Plan Name: Block No. ,!-
Project Name:
DETAILED'DESCRIPTION OF WORK:
C00-0 k"n - G 7XV,oZ
L 160 - g(v
CONSTR'UC'TION 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 A/ Roof �Pitch
Total Sq. Ft of Construction:-2)m -& Sq. Ft.of First Floor:
Cost of Construction:$ 000,00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameTQf- oyy- (cra Nc)tb Q LLC. _ Name: IMAnce.l SWO-
AddressASO liver 17rotio CompanyM ckc�e,J `Jlig ApOF.n4 INC.
City: Knrj P.tr'tie State:� Address:3q3
" _
Zip Code:3y q c((D Fax: City:UQfO ( I/1 State:
Phone No. Zip Code: Fax:
E-Mail:(9&oA4 b(,,e-`7ra g a Mb;i•com Phone Nor�)7a-L(oS-a34 y
Fill in fee simple Title Holder on next page(if different E-Mail C.(nc'b( �(-�'172� •�'"�
from the Owner listed above) State or County Licenseac 51 Iq
360!Z12-
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 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 UVROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ONNP JO SITE BEFORE THE FIRST INSPECTION. IF YO INTEND T TAIN FINANCING, CONSULT
WIT O A ORNEY BEFORE RECORDING YOURAOTJO OrfA)MME)VCEMENT.-
igndfure of ne essee/Contractor as Agent for Owner ignature of Cont actor/License Holder
STATE OF FLCOUNTY OF ORIDA �.� COUNTYOF ORIDA_STATE OF ,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4 day of 204 by this Z�ay of C Com— 204 by
Name of person making statement. Name of person making statement.
Personally Known -OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio _ Type of Identification��
Produced Produced
(Sirteo aU - ) (Signature of Notary Public-State of FloridaELLEN VAUGHN
Co ZN
Mate of Florida-Notary Publi alCommission No.f
`�YPo�, ELLEN Commission #GG 270079 ate of FloridaMy Commission Expires Commission #������ c o er ,o .� ommiss
R - NT O 1NG SUPERVISOR PLANS VEG r E
COUNTER REVIEW REVIEW REVIEW REVIEWREVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19