HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \a_ 1�\�0\ Permit Number: �
dNyLD
COUN 24
- Building Permit Application ST' Lucie CeMrltY, Permitting
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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: q o3 F-100A �
Property Tax ID#: SwA `, — 1 —Ino- - F5 Lot No.
Site Plan Name: Block No.
Project Name:CJX<- ei-J
DETAILED DESCRIPTION OF WORK:
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-1a C Y-i CfVD CAI1•
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 XRoof _Pitch
Total Sq. Ft of Construction: V00 Sq. Ft.of First Floor: 797c
Cost of Construction:$j3-1540 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ch 2 Y- t✓ i C-Y Name:
Address: D O Company:
City: Y T 1 C f b State: Address: 2-+n r' 49 '
Zip Code: �y Fax: City: te:
Phone No. Zip Code: Fax: IXA 1
c
E-Mail: Phone No S4 J IS- 183-5
Fill in fee simple Title Holder on next page(if different E-Mail - h n 11,L r`^ M S/"�. e A M
from the Owner listed above) State or County License CC C 13 fo S
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: RECEIVED
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COM ANYNot Applic ble
Name: Name: *OCT 20?9
Address: Address:
City: State: City: Permf
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.
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 J90 SIT BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEADER WAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Ow r see/Contractor as Agent for Owner 7— na ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s! 4 velem COUNTY OF
The fprgoing instr en was ac nowledgd before me The f r oing instrum was acknowledged before me
this.21_day ofC 20� by this ja day of 20a by
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification`s Personally Known OR Produced Identification )�
Type of Identificatioi ^ M Type of Identification
Produced ="%;-�-State
GONZALEZ Produced D4)VQ-JCC I will.--
T LIZETTE GONZ Z
ida-Notary Public ;;J�,;•,b�in#GG 245192 . � State of Florida-Notablic
ission Expires 7 Commission# GG 92 .
elk "`AJ M Commission Es
1gn re of Nota rn� - (Signatu of Notary Pubfie-Sta df Flt rida August 02, 2.021
Commission No. -`I d -la (Seal) Commission No. J .� (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.217119