HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
W'P!•R!>lrfe
COUNZ
F 4 n R
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
PERMITTYPE:��;-��I'Crt�
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential X
Address: c} t K IY(-,yLv
Property Tax ID #: 1 � C — 5 0 -` Q/ J L)�� Lot No. 0
Site Plan Name: �V ` Y-L (-)A)(-)A)!7— -2- Block No.
/
Project Name: �A i 4�e_
DETAILED DESCRIPTION OF WORK:
l5 a, 01p C-4 f-QcL f-
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: $ —Co 7 Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name `/ ! Name:_ P_a�w 1
Address: /UGLY �or��i. � Company: L PCr`r/ C i✓CS l c�
City: -� )-, LuG{ ,e State: _f:q,Address:
Zip Code: 3 L � 2 Fax: % City: f• S ��tC 12_ State: �-
Phone No. `f g (� Zip Code: ��` Fax: ?723 4� -7� 77
E-Mail: �Gi d►? • tc�h i G'l� lam- C . Phone No —
Fill in fee simple Title Holder on next page (if different E-Mail F-f`l I 4kJ `Ku C�
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
44
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Marne:
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
Address:
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."
i
Sig ure o wn Lessee/Contractor as Agent for Owner
Sig ure of ntra r/License Holder
STATE OF FLORIDA
COUNTY OF �- uC
STATE OF FLORIDA
OF S+-. Lu C i-1
cam.
COUNTY -
The far Eng instru ent was acknowledged before me
� day �Y!
The for Bing instrum nt was acknowledged before me
&`day
this of f 2(� by
this of f I 20,;26 by
4dmTu^ZZ i
�4�t/C of.0 '�L/JQ2�d7iZ(
Nam6 of person making statement.
Name�of person making statement.
Personally Known --�' OR Produced Identification
Personally Known ' OR Produced Identification
Type of
Type
Produc ""�► •- SYLviAL0MBARD0ZZi
2fi65
Produ SYLAALOMIRkRDOZZI
IIY COMMtSSi vy
UY COMMISSION # GG 942W5
per= EXPIRES. FepEuary 72, 2024 11 ,,
ic Unde �` �d`'`' �'^
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ra ? EXPIRES: Febttfary 22. 2024
•' % Pubk Uf3S:B
BWWThruN0tW
Os ��?P•� BorAw Thru ANY wtMr'
(Signature —of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida }
Commission No. (Seal)
Commission No. (Seal)
i
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
R ev. 277719