HomeMy WebLinkAboutBuilding permit application •All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
` e v
a o zo Permit Number.
Date: 6-11- US) �{
Building Per it Application
Planning and Development Servlces
Building and Code Regulation Division
1300 Virginia Avenue,tort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT TYPE:
PROPOSED IMPROVEMENT LtOCATIOW
Address: 109 SIF C'Ci�rn i n 0 St-rt.t.'C PSL 3yq Sa
Property Tax ID#: _� 1 �' <<�7" i n o(V Lot No!�L—
Site Plan Name: Block No. 2-1
Project Name:
DETAILED DESCRIPTION OF WORK:
`Tv�s-folia-F,� of Wood Ance-_y26& on North
I•U -erf p+ CCS /ZS S$ _
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• 0. S}c�ilwl c,+e_ 4 A V
t NSTRLICTION 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 i
Total ft Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction:$ LA 2 ®5 Utilities: _Sewer _Septic 469kKRg Height: /_4if
019�1NER/LESSEE; CONTRA,CTtSR°< uvY
Name Name:
Address: l[kn Se Ca.— O' St Company:
City:_ `PSI— State-1 Address:
Zip Code• 7JLP%3: Fax- City: State
Phone No. 7 a1-l a($ -S 11-7 Zip Code:
Fax: —
E-Mail: �°tY1Cao K Nvo`, c orr> Phone No
Fill in fee simple Title Holder on next�age(if different E-Mail
from the Owner listed above) 41
State or County License
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC Is$7,560 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:
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 instaiiation 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 grantinga permit will authorize the permit holder to build the subject structure
which is in conflict with any pplicable Home Owers Asscition 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."
re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
thii day of 2001 by
.-.r.,.1. Lg (X, Ci -( -AL
Name of person making statement.
Personally Known OR Produced Identification v
Type of Identification ^I
Produced
(Signat re o ry Public-to)%tFI jda<I�a Ass Kelly Mol
.o„ NOTARY PUI
Commission 'STATE OF FI
i Comm# GG2
e ta'1`a f vnirac 911
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
,Signature of Notary Public- State of Florida )
mission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 211119