HomeMy WebLinkAboutSmith, Mary 5208 Sunset BlvdAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Lute:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 452-1578
PERMIT TYPE:
Permit Number:
Building Permit Application
PROPOSED IMPROVEMENT LOCATION:
Commercial Residential V/
Address: 59-08 51_'(_QCA Z l V d
Property Tax lD #: _ 340- Lot No. o
Site Pian Name: la P i Vt` i Block No. 5?3
Project Name: I` ay
DETAILED DESCRIPTION OF WORK:
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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: $ ! l . �� l QC� _ 'Utilities: —Sewer —Septic Building Height:
OWNER/ LESSEE: CONTRACTOR:
Name �tic l`# Name:_ Lonnie Q s l beft5Gf)
Addre55:+7f UI�l Company: tl' it 1 'r 1 i
City: Irr1-. l State: EL Address: 1O I\i 1 1L1 Ci l 711IC$
Zip Code: k `� - Fax: City: uenl lbs 3ch State: i L
Phone No. `��i -R` I—(���I' Zip Code: 3Ltg17 Fax: -772-22-5--1Cz7 7
E -Mail; Phone Nod' 2(c
Fill in fee simple Title Halder can next page { if different E-Mailcv
from the owner listed above) 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: , Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
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 inoscateo.
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 Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, l 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 IMPROYEMENTS TO YOUR PROPERTY. A NOT110E OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
1'IrIITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Ignature Owner/ Lessee/Contractof as Agent for Owner
Signature of Contractor/License Holder l U4v 1 Cll4 c ;�i
of
w N iJ .E r`'i.tLaepi bj
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF "a-(-Vifl
COUNTY OF M ArRTI Psi
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this L(; day of iii CLL] . 20;�Lb by
this day of 20� by
,l LL n
Name of person making statement.
Name of person making statement.
Personally Known Z OR Produced Identification
Personally Known _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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{Sign ure of No a Public- St f 1 r'
at re of Nota ubl'
PNort�ary Public State 0 Flo
Commission No. S1611yn F Wilson
& Notary public State ofFlorid&
Co mission No. .fBcl1' e�[�30[t
My Commission GG 275484
j* Expires 11/0812022
My Commission GG 275464
# Expires 17lQ812022
REVIEWS
FRONT ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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