HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPC_-. _J FOR APPLICATION TO BE ACCEPTED
Date: J7_afL Permit Num e �t Cl
LL
0 MAR 17 2020
Building Permit Appli Fitting Department
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential )<X,C
PERMITTYPE: �E, !�,It'{ PQsIclert-hn_L
Address: G%11?_-
Property Tax I D #:
Lot No. 4
Site Plan Name: H-1ym /3P g-g Z c �f/y b Block No.
�2_ - Don In —
Project Name: m 6 r,,J ,.lC 5 r ctz. lid -vase I A
14 oC CJ,, i'7"-1 r. 9 P
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 6�/Z Pitch
Total Sq. Ft of Construction: J C)(:�) Sq. Ft. of First Floor: 1-7(, 3
Vl/
Cost of Construction: $ 1/3 Poo . Utilities: _Sewer Septic Building Height: 17 r 10"
Name Re_"n_-r ... ,_c,c _ 1 1L
Name:
Address:. 12,5'd /Lt1,Nria, PNvd S,n:1.i
Company: enci ;_),ICA�'(S LL.CJ
City; CL5��,w ,a State: FL
Zip Code:--14c� `7(� Fax: 77,2-- f,_,`'JA- 91S5�
Phone No. 'J %w"? .
Address:12�7,,L_95 S f /k5 f ()Pon , y� 0u,� to
City: �S� Ait State:' FL
Zip Code:-,._59cl"i 6, Fax: 'IT° — (o07 �_Tc /,5,,.
Phone No 17a - 4q 2_ 7f'(J'7j
E-Mail: �r a UnA>�ow& C rsts�;?n��.;:C^,'rr!
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License 4'_13C.
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON$TRUCTfON i,I�N 111W INFQRMRTIOW
,...
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State: _
City: State: _
Zip: Phone
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 indicated.
I certify that no work or installation has commenced prior to the Issuance of a permit.
St. Lucie County make no representation that is granting a ermit will authorize the ermit holde to build the subject structure
which is in conflict witt au applicable Home Owners Association rules, bylaws or anScovenants lat 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
0
Owner/ Lessee/Contractor as Agent for Owner
tigirdiureIFILORIDA
Sign ure of Contractor/License Holde
STATE
STATE OF FLORIDA
COUNTY OF iS� LLjG e
COUNTY OF SA l_s_IcA
The forgoing instrument was acknowledged before me
The for oIng Instrument was acknowledged before me
thisL day of M A-fC4. 202c) by
this % day of f`r\n rc_h 20 Zo by
Lt 51�'- Irn C-, i 1A
cli-e h r\ A-Dpto e�-�-
Name of person making statement
Name of person making statement
Personally Known ✓ OR Produced Identification _
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced / S �/J�
Ak LM j. . l l A L.0 I [ -e—
Producee1�d' ^_ I //���m. -
/ � k Y 1 a,'S', w K�/"'�-
gnature of Notary Public- StawUhl"E
(Signature of Notary Public- State of Florida I
`�1Q¢fi56
Commission No. ':. •, Commission#a 1
RHONDI§Cr
Commission No. E
—commission
tt; • a•� spires May
Bonded ThmaodgeWotsry Serves
# GG 104656
Expires May 15, 2021
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Rev. 8/2/17