HomeMy WebLinkAboutSt_Lucie_County_permit_applicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: aha)u�n ke( Name:
Address: g:E)2t,j,, Address:
City: G(lar.��1n State: FL_ City: State:
Zip: -t,2951D Phone Ao1- Zcilo-lncip Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:_
Address:
City:
Zip:
Phone:
Name:
Address:
City:
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."
Sign ureof Owner/ Lessee/Contractor as Agent for Owner Signature of Con6actortli6nseHoTcler
STATE OF FLORIDA
COUNTY OF Ro_, ,,,U
The forgoing instry rnent was acknowledged before me
this `Z-lday of y � 1 , 20 Zo by
Name of person making statement.
Personally Known �_� OR Produced Identification
Type of Identification
Produced
STATE OF FLO ID�4
COUNTY OFa lnA ia�,h
The Forgoing instrument was acknowledged before me
this 2_7 day of NV6\ 202-2- by
v_& A , 16,rc) aV rn
Name of person making statement.
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
e
Jeffrey J. Perusse
(Signat of �' ted Y $,23 (Sign G f Nc
Commission No. BomW TjlAal' n Notaq Commission No.
tatedw."d Q414
3m*d Ttn Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE ! MANGROVE
j COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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 TYPE:
Permit Number:
Building Permit Application
Commercial ✓ Residential
PROPOSED IMPROVEMENT LOCATION: _
Address: F3`41() CorY,mt�c ^a�-,i-,'/ T 01'1jr' Pr`x+ _`4.�l�rar. ���10l�
-- - - k - —
Property Tax ID #: 3732-7' Lot No.
Site Plan Name: Block No.
Project Name: L1 CLv--6Itr�
DETAILED DESCRIPTION OF WORK:
m
\r4 COV L7 & 1� r '1F . \ . t , , i C , , 1-'l', t`-( • CAYb1 J / C -li.A 11 Lw\r'
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank _ Gas Piping
Electric `Plumbing _ Sprinklers
Total Sq. Ft of Construction: —2-(o, _7604*
— Shutters _ Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ I0,to(-10 Utilities: ewer _Septic Building Height: -;.:5 1c`s-rrt)
OWNER/LESSEE:
Name \-\CkCU c �,+ixNenk` I 1 C
Address: \2A W 1 t -o W
City: V-t�,yY. is State: Ga`
Zip Code: 00D\ -2-413 Fax.
Phone No. q { 2-70 - `c' -Y -)U i
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:
Address: 201 Jrcl S
City: `- 0.r \+tX064- State: F I-
ZipCode: 33"{(02 Fax:
Phone No '5 01- 5f3.Z - 5-,-3q-:5
E -Mail \Sale.n ]t'rU1L[ j,CUrr
State or County License C 13l° (� 310N S<i�l
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.
COUNTY`
F
L
O R I D A
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 TYPE:
Permit Number:
Building Permit Application
Commercial ✓ Residential
PROPOSED IMPROVEMENT LOCATION: _
Address: F3`41() CorY,mt�c ^a�-,i-,'/ T 01'1jr' Pr`x+ _`4.�l�rar. ���10l�
-- - - k - —
Property Tax ID #: 3732-7' Lot No.
Site Plan Name: Block No.
Project Name: L1 CLv--6Itr�
DETAILED DESCRIPTION OF WORK:
m
\r4 COV L7 & 1� r '1F . \ . t , , i C , , 1-'l', t`-( • CAYb1 J / C -li.A 11 Lw\r'
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical — Gas Tank _ Gas Piping
Electric `Plumbing _ Sprinklers
Total Sq. Ft of Construction: —2-(o, _7604*
— Shutters _ Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ I0,to(-10 Utilities: ewer _Septic Building Height: -;.:5 1c`s-rrt)
OWNER/LESSEE:
Name \-\CkCU c �,+ixNenk` I 1 C
Address: \2A W 1 t -o W
City: V-t�,yY. is State: Ga`
Zip Code: 00D\ -2-413 Fax.
Phone No. q { 2-70 - `c' -Y -)U i
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Company:
Address: 201 Jrcl S
City: `- 0.r \+tX064- State: F I-
ZipCode: 33"{(02 Fax:
Phone No '5 01- 5f3.Z - 5-,-3q-:5
E -Mail \Sale.n ]t'rU1L[ j,CUrr
State or County License C 13l° (� 310N S<i�l
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.