HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
Commercial Residential L/
Address: .-J00--l�ro�k�1nz iA,.1'r—
Property Tax ID #: 132 - L I l - G (,), -1 - 6o o - Q Lot No.��
Site Plan Name: Block No.
Project Name:
.ED DESCRIPTION OF
ORK:
21
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: /j 5�
Cost of Construction: $ /(9) �ic Utilities: —Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name 0-lrje i` •55i' o"
Name: tfI'ir') arq
Address: "100`�I t�J�CoU irle-- A VZ-'
Company:-SiA�ey+J(C e-Wi�tdop)5 aA/ boe 5 Vi c_.
City: FC114 P"C-rG'-- State: �Fl
Zip Code: 3 LAcLS- l Fax:
Phone No. S' 13 " L[CtS- 130b
Address:.37a5 t;-7>/fd]-rr,eni L�n�
City: Stater
Zip Code:, 3 -� QOLA Fax: S41-t,?Oc�-I�l 110
Phone No aGa. - / 41 o3
E-Mail: (' he--LQ�l 3 (dC-701ad ,('alr7
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ifi WfjIq 0, lf-W Ld e-t rn,2cJWincctoyS cL
State or County License .5CL 131 1,Sa oa f
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."
Signature of Owner/ Lessee/Contr ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORI
COUNTY OF Cn �,Y� �'�
STATE OF FLORIDA
COUNTY OF CAI kj�
The forgoing instrument was acknowledged before me
this UQ day��
f o, 20 aoby
The forgoing instrument was acknowledged before me
this � , 20a6 by
day of I?ice
�oj
0_)n Ji'" �5 h
/V> /
,-rJ ren,
Name of person making statement.
Name of person making statement.
Personally Known ( OR Produced Identification
Personally Known �14 OR Produced Identification
Type of Identification
Type of Identification
Produced
A
Produced _
(Sign ure of No ry Public- State of F rida )
y
(Si ature f oar Publi - State of Florida)
Commission No.Fa KIMBEtr'�t.'11rKCLLY
J. ommissi 208493
Commission Expires 04.18-2022
?� Bonde Throur h - C nan t r
G' �I RLYAKELLY
Commission No. 1� ti� _ CuNmn # GG 208493
{ ° Comrnissian Expires 04-18-2022
�% h - C nanotar
REVIEWS
Florida - Notar
Public
OR
PLANS
VEGETATION.
oWO nori
- A,TURRTiW-_
a - Notary Public
04AWGR 3
"
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19