HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �• �I.e ��— OL;J Permit Number:
2,00 1- 0 2A
Mimi
RECEIVED
Building Permit Applicatio JAN 16 2020
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division g
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553. Fax: (772)462-1578 Commercial Residential
PERMIT TYPE: W• O
PROPOSED IMPROVEMENT LOCATIO
Address: 'Y001
�/ S /N4,,A?J A.1,7z 04
Property Tax ID#: 0��3(o - -7 - a27 �/ Lot No.
Site Plan Name: ie4e Block No.
Project Name: �AiL
DETAILED DESCRIPTION OF.WORK
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//1/,.v�� �u�.�- -- aP�/•x,65 ��'�
CQNST_RUCTLQN INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plu Bi/ng _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: / _V•0-D Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
O .NER/LESSEE ;- CONTRACTO
,WR
Name_J',•r-N- 'Pwgi :f Name:
Address: kk3 0% .�WAOAO Oty42� /7 _,�� Company: I-ewe' a4/q'WAW'-1
City: A44- 9'&-V e'� State: f2 Address: //?Z /
b u
Zip Code: Fax: City: TLA-x� state: Ali
Phone No. q11- /&77 Zip Code:3 y 9 9T .Fax: 92 '?74,y
E-Mail: Phone No t'J SZ-o,-)qJ
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County LicenseC(3 C fr&3 y 3 7
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 IN,
. , s �...
.. _ .
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.
1
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:ro additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to a o r non-residential use
"WARNING TO OWNER: YOUi%TrORNEY
RE TO RECORD A NOTICE OF COMMENCEME Y RESULT IN YOUR PAYING
TWICE FOR IMPROVEME YOUR PROPERTY. A NOTICE OF COM ENC T MUST BE RECORDED AND
POSTED ON THE JOB 5RE THE FIRST INSPECTION. IF Y D OBTAIN FINANCING, CONSULT
Wrry YOU LE R R BEFORE RECORDING YOU N E O MMENCEMENT."
Signature w ssee/C tctor as Agent for Owner >gnon`tra o ' nse Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF }'QAi iVIJ COUNTY OF ma&�r3
The for oing instr ment was acknowledge efore me The f r oing instr e t ac owledg efore me
this day of ` 20Zby this day of l 2 b L
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
(Signature of rrVar/y Public-State of FI rida) i e o N a Public- tate o Flori
Commission No.6)t17 3 r1 Q 2_ al)Notary Public State of bride /� �� ota I StBpgeste of Florid
Angela Staples Commi ion No. C?
y Commission 23510
i My CommissQ71 /�22 M
2 5102 ,� Expires 071041202222
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REVIEWS FRONT Z W ERANS
PVISOR PLVEGETATION A TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2