HomeMy WebLinkAboutBuilding Permit Application JAN/10/2020/FRI 12:32 PM ACCH INS AGENCY FAX No, 7724085501 P. 002/003
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Apr IicationlAN 10 2020
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 S t, Lucie Cy, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT TYPE: ��GI
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Address: la
PropertyTax lD#: ! " �0�� h ����b–� Lot No.
Site Pian Name: Block No_ q
Project Name:
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Additional work to be performed under this permit–check all that apply:
_Mechanical —Gas Wank _Gas Piping _Shutters _ _Windows/Doors
Electric ,,,_,Plumbing _Sprinklers _Generator _Roof Pitch
Total 5q. Ft of Constructionp:. . _ ___ __ Sq.Ft.of First Floor:
Cost of Construction:$ O��� L70 Utilities: —Sewer _Septic Building Height:
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Name_ �,�,�(� Name: f
Address: "�ie, a Company: R-`-}--m l7Sms l�L ,t�
city:_n 1 — State•,F Address: q35 sr. Co t k e `
Zip Code: Fax: City:ea, Stater I
Phone No. ~~ Zip Code: i{g Fax:7 2,2 7 D 1
E-Mail:_ r Phone No 7��-A��?�-)-?SIP
Fill In fee simple Title Holder on next page(if different E-Mail '041ioTof]e1 fC-:�;CAQi Q.1,hoo. !-OM
from the owner listed above) State or County License EC 1 Sap 7306
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is VM0 or more,a RECORDED Notice of Commencement is required.
JAN/10/2020/FRI 12;33 PM ACCH INS AGENCY FAX No. 7724085501 P. 003/003
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Stage:
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 priorto the issuance of a permit.
St.Lucle gun makes na representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult au
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
"WARNIIIIG 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. W YOU INTEND TO OBTAIN (FINANCING, CONSULT
WITH YOU LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
g ature of r else oras Agent for Owner acute of C tactor/ er
STATE OF STATE OF
FI_
COUNTY OF O__;'T. LUGI�f, __ COUNTY OF O��Gi'e
The far sing inst ent was acknowledged before me The forgoing instru ent was acknowledged before me
this ,day of ° 20�Q by this Ii d dayof 20RO by
Name of person making statement. Name of person making statement_
Personally Known (D OR Produced Identification Personally Known OR Produced identification
Type of identification Type of Identification
Produced Produced
( )j JL . c'U1,I& ___- - - 0% - - -
ignatu a of Notaryubli (Slgnatu a of Notary Pub lo-St o �-cla�ktarY Punuo Stata4f Florio
NotalyPubltCSratedFlonde �' �• Melissa L Butterfield
Commission No. - tea; M��� Bytterr�eld ommission No. (S S a; (�+��]] mmwisibn GG 30209
Nd
�1 My'Com lemon GG 302085 a 11t�e oy14/2023
`7}1y� ExpirOs 02/14/2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19