HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CO., v,� TED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number -A' D�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Rit-A-
Building Permit Application p 251#?�
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St.��� g pep
�e Cov tv ant
Commercial Residential K
I YKUPUJtU IIVIi'KUttVtIVlt:Nl LU_ CAI IUIV: - - -
Address: 6161 � IL-i () f-k - 0 i rC�1� FI. 3(191 a
Property TaxlD#: (00 IDOO-
Site Plan Name:
Project Name:
Lot No.�
Block No. ZD
DETAILED DESCRIPTION OF WORK:
E)(-ft1JDlNCy POI/ le'Dor 1q, Fo Er/p OF yoBSc P-ooF
For COUG(Ze fl PPrtc7
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: (?b Sq. Ft. of First Floor:
Cost of Construction: $ 2-%50 "'—mo
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameN 0-< ur
Name Yleu.IN w/� Cho�S
Address: l li
I (
Company: Kvxt ILA 1'It,-Y -1 Pi LL
City: � Pio,f t.e, Stater
Zip Code: 34 clftsr Fax:
Phone No. `)-?D -c .� - 0S
Address: aQaa_ Sw �JI�+1��fJC' S'("
City: Porgy Si. Loci e, State: F I
Zip Code: `;4c1S3 Fax:
Phone No '112-1;I4-310aa.
E-Mail:PQION tl 3eroo;,+Q ui 0 9p-,A I -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 17inr YY'1 LA Q MC v I, C 0 r+
State or County License 6 U' i qk
If value of construction is 52500 or more, a RECORDED Notice of Commencement Is requlrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRZ,,SN
LIEN LAWINFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
7SNot Applicable
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 contllct 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF T (—Lc e
COUNTY OF !!�r [.o c_; e-
The forgoing ins[ ent was acknowledged before me
The forgBoing instrument was acknowledged before me
this day of ebr✓Carl .2020 by
this /Y day of e u 2020 by
hO14)
N ickbh
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio .
Type of Identificatio
Produced
Produced L
Signa re of Notary Public- State of Flori,{fe')'uF ALYSSA A.T.
300111t re o otary Public- State of FloridgtityPua ALYSSA A.
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DATE
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DATE
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Rev. 2///19