HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � r ����� Permit Number: a.d�a'd 5�
RECEIVED
FEB 18 PJ70
Building Permit APPL99Qounty, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
I PROP()EW4MPRQUEMENT.LO,CATION;' ;; l
Address:
Syr-atCC
Property Tax ID #: -3//N4�I S1 - 70 S" 00,AA - 000 -7 Lot No. '2 f
Site Plan Name: �t4"2t��h fkw-kwp 1l�: 4O/ � ,A� e W Block No.
Project Name:
GONSTRUCTIC Nl [NFORMAT.ION: ,
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_ Electric _ Plumbing _Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Roof Pitch
Cost of Construction:$ 16750 Utilities: _Sewer _Septic Building Height:
OunrER/LESSEE
CONTRACTOR
.,.
Name V1nh&�� 14 r�...,
Name: �JR-s'O'k MCM46
Address:_('$OT Gi�PstGl %�i'7 a CZ'
Company: Sks�tla
/- t ! j iF B' 5CPr1C�
City: �454 tCCrP- State: FC
Zip Code: Fax:
Phone No. 74
Address: . - X
9Gy5
City: �br1Sl G�Clf State:_
Zip Code: 5Y,761Fax:
Ly
Phone No aha
E-Mail: 1161L
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail u l i (,ae,
@ � vrco�
State or ounty License
C q57032
It 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
Name:
MORTGAGE COMPANY: _ Not Applicable
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 bylaws
rules, 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 YOURNOTICE OFF/CO`MMENCEMENT."
--
SigrVature of Owner/ Lessee/Contractor as Agent for Owner
SignatuM of Contractor/License Holder
STATE OF FLOKIDA
STATE OF FLORIDA
COUNTY OF . �—Jc �e
COUNTY OF LJ c \C
The forggding instrur9ert was acknowledged before me
this \�6 day of F�'O 20Q.a by
for
The going instrument was acknowledge$ before me
this\ day of Ve, % 20;k by
e`
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentifiVion
Produced L- �'�
Type of Identification
Produced rL.flL
(Signature of Nota ublic- State of Florida)
(Signature of Notary blic-State of Florida )
Commission No.%6.O (Seal)
Commission Nlz�• ?-p [NA MA 114 S
IE GIV'rN5
NNAMAR 23
y.= OMMISSION # GG 022023
EXPIRES: December 16, 2020
REVIEWS
FRi�ItT
COUNL; q'R6A�fE4�"
N9 COMMIS
dONW5-s!0e
N°
eta, 2020 r
PEJi0rfSFiR11
PLANS
REVIEW
'.P, ��;,,,' °
e ttw Notary Public U.^.:envdim
WN ROVE
REVIEW
V
REVIEW
REVIEW
DATE
L ��
RECEIVED
DATE
COMPLETED
ev.