HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BEACC EPTED
Permit Number awo, avids
RECEIVED
FEB 2 5 2020
permitting Department
Building Permit Application qt Lucie Countv
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349112
Phone. (772) 462-1553 Fax (72) 462-15M Commercial Residential
Address-.- coax 44-,E X ArJ bP- t- A C-r-L, Ph, P=EC14 As I FLd, 3996'�
Prc)pertVTax[D#: 34//D — 5 03 — 01 S1 — Lot No. ///
Site Plan Name: p)(VL-, 0--a-otc '13 b Block No.
Project Name: e e3 nn E A- PA 7-Z0 EJ e-� (S2,E
1-CONSTRUCTION INFORMATION:;
Additional work to be performed under this permit- check all that apply:/Mechanical — Gas Tank — Gas Piping — Shutters V/Wlndows/Doors
_IElectric —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.
CONTRACTOR
Name MA&V in a 4gr /Z-
Name. fi 0 6 C- a--r- Q P-C--LAY—E R-
Address: &6107' AGEX4;fb AZ -A (1-=A.
Company: SAELL
City: r—r P=ee-aa: -State: r-a!-
Zip Code: 39f9,fc;L Fax. --,A/ A—
Phone No. '72d 9 -'/0- 91 z1 9'
Address: `rya 9 S,
City: Fr, PXEZCC State: r-4-
Tip Code: 3VOa Fax: ?,7,,l -
Phone No
E-Mail:- F�Le b, 0 `2 8 E-u- SD6 -r-A
Fill in fee simple Ildle Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License 0 G C9
ff value of amstruction is $25DD or anxe, a RECORDED Notice of Commencement is re*Wed.
If value of HVAC is $7,SW or more, a RECORDED Notice of Commencement is Feqube&
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SUPPLEMENTALCONSTRUCTION LIEN,LAW
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INFORON
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Tip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:Y
Tip: 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.
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
`WARNIM TO ONIfBC YOUR FAw rIIIIIIIE TO RECORD A NOTICE OF CDi8110ENENIF MAY RESULT N YOUR PAYMG
TMCE FOR EIIPROVENIENIPS TO TOUR PROPERLY. A NOTICE OF COMMENCEMENT MUST BE ICED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
t41TH YOUR LEADER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature ee/CormactorasAgent for Owner
Sign of Contractor/LicenseHolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �r Lv r i t
COUNTY OF sr L•vc i
The forr&ing instrument was admowledged before me
The forgq' instrument was acknowledged before me
thiiss�� day of � 20 1b by
this 11 ifayl of I",rJ_gT 20Q. L by
K.J �•2.r� �f2.r,J ¢✓•
IL>/T�/7� � t'E.�"ei/
Name of person making statemert
Name of person making statement
Personally Known OR Produced Identification
Personally Knovm,--� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
0 ,
(Signature
(Signature of Notary Public -State of Florida)
WANDABREWER
"'.
Commission
Commission No .•"t"''•• WANDA9
�' a E1 IRES:April27,2822
to MYC0MMISSIDNg00I88s58
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FRONT
REVIEWS
ZONING
SUPERVISOR
PLANS
VE
OVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.217119