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Home My WebLink AboutMidway Specialty CareAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fart Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERMIT TYPE: Pcn(�c 110+ I On PROPOSED IMPROVEMENT LOCATION: Address: V) C -_Cir 1 1� Property Tax I D #: Site Plan Name: _ Project Name: _ DETAILED DESCRIPTION OF WORK: o4. Residential Lot No. � p Block No. 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: $ 'Utilities: —Sewer —Septic Building Height: OWNER/LESSEE: 0,N7RA, OR: � COUNTY F 1 y3 R 1 D A Permit Number: Building Permit Application Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fart Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial PERMIT TYPE: Pcn(�c 110+ I On PROPOSED IMPROVEMENT LOCATION: Address: V) C -_Cir 1 1� Property Tax I D #: Site Plan Name: _ Project Name: _ DETAILED DESCRIPTION OF WORK: o4. Residential Lot No. � p Block No. 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: $ 'Utilities: —Sewer —Septic Building Height: OWNER/LESSEE: 0,N7RA, OR: Narne Ci n Address: r7 Name: rllaawn Company: City:-} 1rr''[ Stater --L `�'1 Fax: Zip Code: �4ha_ Phone oL) rt E-Mail.DRN1 . Fill in fee simple Title Halder on next page ( if different from the Owner listed above) Address: City: . C State: Zip Code: Fax: PhoneN E -Mail a 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. 110 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: Zip: Phone City: Stater 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. Lucfe 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 AI IURIMLY btrUKt RtLUKUIMP iUurc NvIILL wr a,vmmrna.rm=[rIJ6. VQ i� _ Signature of Owner/ Le see/Contractor asAant for Owner Signature of Contractor icense Holder STATE OF FLORIDA STATE OF FLORIDA . COUNTY OF 5 �. 2- COUNTY OF_ • /_ The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me this i� day of Y �i � 2O�0by this `� day of 20 by Name of per o making statement. Name of person making statement. Personaily Known / OR Produced identification Personally Known _ ✓ OR Produced Identification Type of Identification Type of identification Produced _ Produced _ /ZZ (Signature of Notary Public- State of Florida j Commission No. �& RICHY DOMES ,. p"a, RICHY GOMES, JR. (Signature of No � t� ii$9r PA GG 966763 ,,*`qa; M Commission Expires Commission No.2"E. March 24 REVIEWS��n # WS R PLANS VEGETATION SEA TURTLE MANGROVE " ftef R V46WhFo8, 20 REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED r 17� '10�1 0_,, cn CD C"D c:13 0 co -19 C= w ."'4.r. 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