HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: k NS Permit Number: �°� >>�d3 I-dN
RECEIVED
• NOV ® � >�R�
Building Permit Applic ioEd .
Planning and Development Services ae County, permitting
Building and Code Regulation Division "X
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE: e () e, I f (h ul b
PROPOSED IMPROVEMENT LOCATION:
Address: QUeC',t!1 �Gd1iA ur
Property Tax ID#: (y I L(- rI O( � 0051 - dC1b- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: .,
e(too l- Skn 12 0 ftM1 ',nd 1=a-� = ash
'rrZ-buy lk SM OA N� Under-talmW-l- ��� liars Y1 - R6
N1 0eel 5� cic 6Q& avr! T r& Gown Cap rt-g-
'un ion C8rro6a+in& «pLsoy 5-U UirP (.hoels I• ' Ry
CO'NSTR'UCTION 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 l Roof �� Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:�4 y9
Cost of Construction:$ �.� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:" CONTRALTO .
NameRoSanne, NAo .IL Name: pi ICM(?, om.
t
Address:) (CQ C-05,Qi � 9,Q J6 f)Ck Q+ Company:) .dn(Y&l �(f
City: uoniNsw IS ICM �. State ISL
I,.� Address: y
Zip Code:?Wu I Fax: City:�km bgC In State:
Phone No.'1'la-�fd$•o't3$LI Zip Code:-�)!1101 Fax:
E-Mail. .I.Lf71^^ Phone No —Ila-
Fill
11a-Fill in fee simple Title Holder on n xt page(if different E-Mail m
from the Owner listed above) State or County License 3CLq;�-
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 IN'f.ORMATION;
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.
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 COMMENCE NT MAY RESULT IN YOUR PAYING
TWICE FOR IMPWPEMENTS TO YOUR PROPERTY. A NOTICE OF COM C T MUST BE RECORDED AND
POSTED ON J SITE B E FIRST INSPECTION. IF YOU 1 N5 T N FINANCING, CONSULT
WITH Y N O RNE BEFORE RECORDING N C C ENC NT."
S' ature of Owner/Lessee n or as Agent for Owner ignature of Contra ctoolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me Thefgrgoing instrument w�a s acknowledg d before me
this 1 day of -V)6) 20�by this \ day of �dV 20by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificationType of Identification
Produced W :111D Produced %,,o �--
(Signature of Notary Public tate of Flori ) �'" (Signature of Not - ate EGINEN
� N�{+R1E ,�.��^3 '•s. _::q• �= MYCOMtJlISS1oN# 21)21)
Commission No. 3 D MMS _21 ;` Commission No. {3 c PIRES:Dc'� b �Q 1`r
;r;. Y Cp u b3e 16. i.;s onde N Not` Ya ^dervriiers ...
M ES m undPhifi" ,'•, OF F`OP: g dTh �, ,.iy:;.>;�;:.
•'s= �(p1R 1aNpubllc r "�a
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REVIEWS F ' ' "" NG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CO ER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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