HomeMy WebLinkAboutBuilding Permit Applicationt ye -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �23 �2 O 2 (% Permit Number: CDI - Ulw%
- - -- Building Permit Application RECEIVED
Planning and Development Services .IAN 3 t. 7A20
Building and Code Regulation Division Permitting De
2300 Virginia Avenue, Fort Pierce FL 34982 st. Laertment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓✓ -oa°ty
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
ProjectName: Tra-vo-ssos P,0-SQ 4.4,La
Lot No. 3
Block No.
I DETAILED DESCRIPTION OF WORK: I
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
_ Gas Tank
_ Plumbing
_ Gas Piping
_ Sprinklers
3 bca�h
_Shutters —Windows/Doors
_Generator _Roof Pitch
Total Sq. Ft of Construction: 3,`1 I S Sq. Ft. of First Floor: Zrc/ 7-
Cost of Construction: $ y00 K Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Namefko4tk,. Doris T/Ay"sOS
Name:
utl&. Qom,a
Address:9/7 /O/Yt_ Bewob Sfi
Company:J.M, Qrtoy Cor�SIY4Lhe
City: dc�� cai State: FL
Zip Code: ?Z Fax:
Phone No. "?2.1- 74 S-s3bZ
Address:1/2249 Y'^ 7Dvc
City: ,VL4-0 64,a rh i^h Z State:_
Zip Code: 3 ZI G 7 Fax: "—
Phone No 772.-5-" -Ofv7,5
E-Mail: j+ra,vnL6SnS (I
Fill in fee simple Title Holder o ext page (if different
from the Owner listed above)
E-Mailer v(7 n't" Qj MV-L.I d W,%5'fV--L4'y1L. 1-1a w-t
State or County Licensei�4C /SOS13 7i
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: _
Name: E 5 la
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: jSSS 11,a<o.. Ivw
glv f�., 6 I�fS
Address:
City: V•yv Paacw.6.-
Zip: 329bv Phone77-1-31,o-Y43%
State: F L
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 rules, bylaws or ano 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 INTE11D TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICIEFOF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat e se Holder
STATE OF FL RI p�3
STATE OCOUNTY
;;:JA
OF� I Iyy
COUNTY
instru ent was a knowledged before me
The for May W
M �
The fo mg instrument was acknowledged before me
this ay of 20 by
this% ay of 216L by
_1 OS
Bunn AA d
Name of person making statement.
Name of person makings tement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
1�'A djym pa G
�/j/�jrJyW " "E�
�,L 11 Fe
(g ature of ota Public- tate of Florida )
it ature o otary Public- State of Florida)
Commission No. 4 Z 4 taNoteryP" CstateaFl
f
is *on No. GZ fie"' SePlb)anPueuasramor Fit
Jenmfer M R chm
MY Commission GG
n Jennifer M Richmond
89481 My Commission GG
a
REVIEWS
FRONT
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VEGETATION
SUPERVISOR
PLANS
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COUNTER
REVIEW
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DATE
IJ
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I�
DATE
COMPLETED
Tev.277719