HomeMy WebLinkAboutBuilding Permit Application � 7
All APPLICAB/E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -�/�
Date: ! �`a fl a Permit Number: cQoo
.. � RECEIV5
�COUNTY
AR1 � `1�2J
Building Permit Applic tionM
Planning and Development Services Sr. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 1/
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 109
a k 0 .!S+ -rOc'+ Pi>f- r�
Property Tax ID#: J!53 71- kn.I 0OSk-oho Lot No.
Site Plan Name: ® Block No.
Project Name:
DETAILED DESCRIPTION OF WORK: 'a
ro rJQQ e-7-1-e_ -r- rA1VCR!PTE :S000 eC 1 W JfiJ Lr
FCONSTRUC-TION1,N'FO'R'MATION:, .r
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: 600 Sq. Ft.of First Floor:
Cost of Construction: $ 15, 4 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name iR F a CJS-&-WJ+n ) Name: -S(Q
Address: ®(n� _C-(- Company: te\C
City: State: Address: I Z�g S Cc rf-L? A(�►�
Zip Code: Fax: City: r-o r+'t C-r CQ State:r-t
Phone No. 'K10,3 -t[1z-(6o4 Zip Code: 3K TIO f Fax:
E-Mail: OX—t-L VS Phone No '7? Q-ac,7 ?,8
Fill in fee simple Title Holder on next page(if different E-Mail Okn c,`sc-L c-'d o 7 7 C@ &-k amu'/- c
from.the Owner listed above) State or County License 6
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.
SUP'PLWENTAL 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 111114PROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON E JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH OUR ENDER AN ATTORNEY BEF913E RECORDING Y0JJR NOTICE OF COMMENCEMENT."
Signatureo wner/Lesse /Contractor as A nt for Owner Signat a of Contras r/License Holder
STATE OF FLORIDA STATE OF FLORIDA A •i _ , n `E
COUNTY OF N COUNTY OF L�,}y
The fo oing instrument was acknowledged before me The forgoing instrument s acknowledged before me
this�day of VAerQGh ,2020 by this�day of M r 2ft by
�OC,E S-ia I C'.t4�b
Name of person makingstatement. Name of person making statement. /
Personally Known v/ OR Produced Identification Personally Known OR Produced Identification I/
Type of Identification Type of Iden ' ' ation
Produced Produced L
(Signature of Notary Public-State of Florida) (Signature of Notary Publ' '
��� ���1YP���i KA EN S. N:1ESEN
Commission No.Mnin'SllS020k tL"I aj'f RAQUELDGUEE LUm�ission No. =_°` `e` cstate. ff8�)ida-Nry Public
R
Commission#G 302984 Commission # 207484
ExpiresFebruary 8,2023 'oFOFe�o:�° My Commissioxpires
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REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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