HomeMy WebLinkAboutBuilding Permit Application JAN-16-2020 15:11 P•01
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date, • 1(_,Q •7- PermwDumber:
rr RECEIVED
_ Building Permit Applicata on JAN 16 2020
Planning and Development Services
Building and Code Regulation Division ST. Lucie County Permitc.ng
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
Address•
Property Tax ID#: 16 Lot No. Z� _
Site Plan Name: BIoCk No.
Project Name:
Additi al 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: JY Sq. Ft,of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
NamemkCIVAI Name: 110 CCW9
Addre Company:
City: State Addres
Zip Code: 1 7 Fax: Clty: State:
Phone No. -- Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mai
from the Owner listed above) State or County Lic 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.
JAN-16-2020 15:11 P.02
$UFPLMN 'AL: N$T-RI"-, �; AV,INFORM
' ATloP :
DESIGNER/ENGINEER-
Name:
ENGINEER:
Name: of Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address: `-
City: State: City: State:
Zip: Phone Zip: Phone: -
FEE SIMILE TITLE HOLDER: L, Aplicable 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 1 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
TWICIE 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 OB FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM EMENT."
Signature of Owner/Lessee/Contractor as Agent for Owner Signat re fofC&ontractoF/LWnse Hol er
STATE OF C UNTY OFQRID G0. I'" 1 ecj STATE OF FLORIDA). 17A
COUNTY OF
i
Theoing instrument was acknow ledggi ,before me The forgoing instrument was acknowledged before me
IN
g
this day of 4 ,Z by this JJ_day of 20,W by
/ 11146
MAZ_ & i z
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
_ l
r
(Signature of NotaryPublic-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. 0" NotaryFu6kaWe0rFlonda Commission No. '� NE
Pu611d 1�fr1w j.
Mike J SOkolowski Mike Sokolov4lu
My comminon GG 2031013 MmelRjMoe GG 203406
REVIEWS Eft' I PLANS VEGETATI E
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DATE
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