HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number;, 2 ncf,�.��
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- Building Permit Applic3,09n o
Planning and DevelopmentSendces
Building and Code Regulation Division
2300 Virginia Avenue,FbAPieme FL 34982
Phone:(772)462-1553 Fart:(772)4521578 Commercial Residential
PERMIT TYPE: O-e _ Q oo f— -(f(Q-+- 'L)f ,Gf,
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Address: 33 1C) a ey i IA- fely o( ice 3`l61 a
Property Tax ID#: d Ya Z- b c)t - Oa-1 5 - 000 Lot No. 39
Site Plan Name: 1 Block No.
Project Name: r-V 1 A r1�1 Vl 1&k. 61
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Additional work to be performed under this permit–check all that apply:
Mechanical _Gas Tank, _Gas Piping _Shutters _11Vindows/Doors
—Electric _Plumbing —Sprinklers —Generator Roof I J-- Pitch
Total Sq.Ft of Construction: 1-1 1#, Sq.Ft.of First Floor_
Cost of Construction:$ 02 , d,4 6 utilities: _Sewer _Septic Building Height C2. _
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Name
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LA a q (h O 2 Name: C' ��- r i
Address: MC4rqyi 11,A 61% Company: �L 1,(�C go Irl
City: Ef)r 4- Qi e(-Ce-,--- State: Address: 1,116 sL' 44\-mG O
Zip Code: 3"L+9 l SW Fax: City: r+ siz lel-ec, State:
Phone No. r]'�o1 — ''10f�- �J L.o q G] Zip Code: Fax:
E-Mail: Phone No l'�1 �j L I - 9 f .
Fill in fee simple Title Holder on next page(if different E-Mail .If a; l zxy 1
from the owner listed above) State or County license
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.
SUPPL +'lEiVT ECfl11iS t�GTfON LIEN tR1�IVtl FGR ON r} i
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 FflYANCtNG, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCE7MEN117."
Signature of Owner/Lessee/Contractor as Agent for-Owner Signature of ntractor/License Holder
STATE OF COUNTY OFORIDA� Ltok Cl1 l COUNTY OFSTATE OF FLORIDA
The forgoing instrument was acknowledged before me The forgoing instrume t was acknowledged before me
this d 1 day of °24.6 26�0 by this o2l day of20*10by
e � 4a m tri F Sal
Name of person making statement. Name of person making stateAnt.
Personally Known +11_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State o Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED o��i�i�ie% ON
STrA
ev. .ate
,_ Co of Florid
CONSTANCE PROULX a-Notary Public
�; POP? mmis
sion #
:�=O��Y PUeini Sta to of Florida-Notary Public ��%, FF��
� GG 258328
°,����` MSe ommission Expires
=. Commission # GG 258328 Ptember 16 2022
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