HomeMy WebLinkAboutScan_2019-11-20-110419091All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
ti - J'
•
Building Permit Application
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 I�
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 8 GV AVA AAI
Property Tax ID #: -7/ 6 y D.0-0 G C 8o cJ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
HVAC_ Lake re) 1z Li 14 /y .SL�/z_ PAGK,09-e_ Ci ;
CYA,.,-, pro.N 3 _)OW 6o K w JreQi
made,.- t3t-1 L Y d 36a►
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 _ Roof
Total Sq. Ft of Construction:
n
Cost of Construction: $ q4'?O
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Sr=�,,, e �i �A rt CSS
Name: .c F ALMt�O%
Address:49 (t,A'yA L -j
Company: &r,4,v ILL L %chl "OCyg/ES
-
City: '0i=1 S -k ""lt State:f�_
Zip Code: -34q-52 Fax:
Phone No. ► > > 7 0i'z�q
Address: 157k N11-KM4= y,ee Clectt.
�
City: A%'I'-.Si 1"ciC State: F`
Zip Code: 3995� Fax:77;- 33S
Phone No 77a x.35 ao6/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail CCt-4..✓ /S -)k Oi &O .coM
State or County License Ga - Co S$ 660
if value of construction is $2500 or more, a RECORDED Notice of Commencement is requirea.
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
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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 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 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."
, zzo 0/, e ?, 6 �
4zwl� 6,e4��
Si re of Contractor/License Holder
—
Si e of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA�+
STATE OF FLORIDA,
C-ud:�
COUNTY OF S T Lucie Coon.1Li
COUNTY OF .S -j- vett
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -'v day of N0UGm(32_-,e, 2049 by
this zo day of 4V6U6MG&&- , 20/49 by
Fi A)Lm-e1(14
`je �� i4GY»e1�A
Name of person making statement.
Name of person making statement.
Personally Known LX OR Produced Identification
Personally Known IXOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission c'n ni
Commission , `PaYP�o, SANDRA V� 8")H
�.+'�,T.�DRASH
<<;�State of Florida -Notary Public
;2 �; a e o Florida -Notary Public
_, �_
_ Commission # GG 197984
_. �=
- 197984
,�
`
e my Commission Expires
,',' oras ,
'%�oFF ��, x gyres
A ril 11 2 22
REVIEWS 202 ISOR
PLANS
ROVE
W
REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. Z/ // 19