HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST,BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Num WMIE
`1i7 �a i C•;C1 u
U.
JAN N rq 2020
Building Permit Appli OPP itting De
Planning and Development Services p t Ment
Building and Code Regulation Division St. L U c i eCo n ty, FL
Virginia 2300 Avenue Pierce 9
Fort Pie c FL 34 82
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
.PROPOSED IMPROVEMENT LOCATION:
Address: 'IVA :Zw pozT Z��
Property Tax ID#: `��.� - c1 p\ Z.. Lot No. S
Site Plan Name: •=�cC
�,�� Block No.
ProjectName:
DETAILED DESCRIPTION OF WORK:
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 /R0of 3 % L Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ SGC Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
06,
Name
1 r Is au Name: r,t r•
Address: % tikw V Company:� ku-ts
City: State: Address:i 9S •c r <;r-
L--,,* � �-
Zip Code: 3 `� g Fax: City: C, L%34.N Cr- State:'I �.-
Phone No. Zip Code: 11j%1- Fax:
E-Mail: Phone No -1'12.(„•tU •ItSa
Fill In fee simple Title Holder on next page(If different E-Mail A-UC, 14 aawl!wScc.-
A2[J6,�,���.f
from the Owner listed above) State or County License GCC %3'3 tk.�,T-
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 LAW INFORMATION:
DESIGNERjENGiNEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City State: City: State:
Zip:• Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: —Not Applicable BONDING COMPANY: ^Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone:.
Zi 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 IMPROYEMENTS 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
ITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:'
Signatureo ner/Lessee/Contractor as Agent for owner Signature of Contractor ceps older
STATE OF FLORIDA STATE OF FLORID
COUNTY OF ' n i) S' Lit- COUNTY OF ),I I�.
The forgoing;instrument was acknowledged before me The fqr oing Inst ent was acknowledged before me
this� .!!day of u - 203 by this /�day of 2Q by
Name of person making statement. Name of person making stateme t. /
Personally Known OR Produced Identification Personally Kno n OR Produced Identification
Type of Identification Type of Identificati
Produced Produced
v
(Signature o otary Public-State of Florida� ) (Signature of Not Public-St e oAU
I r'
Commission No. �:•"•��(Seeo1MnI�gRA1l00i1l00242t0! Commission No. :'.'�"' REl(
GO 300817
�^ r 60"dWp n.2022 �= EXPIRES:March 0.2023
�w R n��MNrp - ••.NoF i;3•''Bq��ituu Notary lh�defv�e�a
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGET
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.2/7/19
I