HomeMy WebLinkAboutBuilding Permit Application r
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �{
Date: 1��5`aa Permit Number: adcj � -aa� b
r`4 R.ECEIVED
Building Permit Application JAN 16 %020
Planning and Development Services ST; gpwn.Gy, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-157$ Commercial Residential %L
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION "; ;r
. F . .
Address: 10 h A N V( JSoyI Fe✓n G+-, -Pa Ir►�
Property Tax ID#:q4 2.5 - 145 06 2$ " 0"v " (f Lot No.T
Site Plan Name: Block No.
Project Name:
DETAILED^DESCRIPTION QF;WQRK ,
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,CONSTRUCTION INFORMATION �E z � � '� ` �' � `'
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 Pitch
Total Sq. Ft of Construction: S9 0 Sq. Ft.of First Floor:
Cost of Construction: $ Ll L41 y 00 • 0 v Utilities: —Sewer —Septic Building Height:
R/ ESSEE s 4 CONTRACTOR d ..
li QWNEL6a „ ,"^ ,� c ea. 74—
Name jtjvYlP.j fm dv- Name: M a
Address: Company: To- t ov r s ec`ali'sJ
City: PArn State: ice- Address: 320 i
Zip Code: 3 4 4 Q Fax: 712-r.72-V13 Z City: 54 ilcwt State: r L
Phone No. '1lz.i�7Z�fd 3 0 Zip Code: L34g17 Fax: 111-9-7Z-0-3
E-Mail: Phone No -1-12,474�5d�3 0
Fill in fee simple Title Holde n next page(if different E-Mail W4A I co((irs SIA lerfts.,1-r
from the Owner listed above) State or County License 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement ie required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is ce it d
vYPUB THERESA JAFFE
„i �� (i�\ \ `? ��•�r`: Notary Public-Slate ofFlorida
Commission N GG 202301
Mv Comm.
"oncea trirougMa iona o ary ssn.
SUPPLEMENTAL CONSTRUCTION ,LIEN LAW 1NFORMATI.QN
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: T
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 COMMENCEMENT MAY RESULT IN.YOUR PAYING
TWICE FOR IMPROVE ENTS TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE J B SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LE R OR AN ATTORNEY BEFORE CORDING YOUR NOTICE Q_E COMMENCEMENT."
Signat a of Owner/Lessee/Co a r as Agent for Owner Sign re of Contra ense Voider
ATE OF FLORIDA STATE OF R1DA
COUNTY OF COUNTY OF
The foLWmg instrument was acknowledge before me The for oing Inst.r�u�mment was acknowledged before me
this 1r day of Jr-
2NW by this day ofJOWLyp j, j 263.0 by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
"o„tiRAY„�,,•
.,. ,� THfEtESAJAFFE
ti►RY"u�- THERESA JAFFE '�' '\�'.r`: Notary Public-State of Florida
.
Notary Public-State of Florida r`; ; ¢`s Commissfon#GG 202301
,
(Signitttrs15ft4bt ° Ci } Si tui+"0$
r Fy, P r 1, [ 7, �Q (Sig ucCiyr�i? I�ECiotQyF lf� )
SoM ed through National Notary Assn.
Coxnn Isis' al) Commi ion No.r'CO j (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.