HomeMy WebLinkAboutAPPL BRIGGSAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential I'-'
Address: l %al ) 0ac
Property Tax ID #: Lot No.
Site Plan Name: T)riC'CJ S Block No. 6'
Project Name:
DETAILED DESCRIPTION OF WORK:
r�lGC`eme -6IL'-- 70(- SiZ�
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 _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ate_ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4I 1 5
Name: 14nc 'e-� kf-h'nal-)
Address: /7CL3 �G` C{-
Company:, � /Jf�k/(d�jlL/hCkuL
City: State:
Zip Code: J3 qc/c�''i Fax:
Phone No. 77�--2i(-0-7i(5
Address:
City: 7) T- i Stater
Zip Code:,J..3 yG`7/- Fax:
Phone
E-Mail: b6r I CIS,3--2_(fC)3 @ C 010t Coen
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail "a/ �1'��f vr/ic�e�. L e�iyirc%�s .Lom
State or County License S C--- Lf� IL2 0,28
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:
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.
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 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 OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign ture of Owner/ Lessee/Contra r s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO �IDA
COUNTY OF ! i oil eG�L`.
STATE OF FLORI
COUNTY OF f cztz 1
The forgoing instrument was acknowledged before me
this � day of NGV 20/q by
The forgoing instrumen was acknowledged efore me
this.2,Tday of J101' 20�Yby
ryc�C'v-
Name of person making statemerif
Name of person making statement.
Personally Known )_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Si nature o otary ub -
(Si nature of otary ublic- ate of Florida)
_
Commission N �v P KIMBERL'('A6KLY
/ o Commission # GG 208493
�j6'&5j`7 %� N Commission Expires 04-18 2022
/ ,SPRY PVg KIMBERLYA KELLY
Commission No. ° o C ion # GG 206493
Com itn s`sW Expires 04-18-2022
�+ �G,�y L� v� o Bonded Through - Cynanotary
REVIEWS `+
�o �`o�
F ida - Notary P
�blic
ISOR
PLANS
REVIEW
VEGETATION
REVIEW
u—
SEA TURTLE
REVIEW
MANGROVE
REVIEW
Ol N ER
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.