HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C � -SAQ
Date: - ! — v Permit Num e[k'r:r_ _ �-• (
• "APR 2 8
. -- -- __ Building Permit Applicat
ion uepartmenty ion
PlanningondDevelopment5ervices Lucie Count , FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMITTYPE:10A)11&-z BOIL..DwZ
Address:
Property Tax ID g: Lot No.17civ
Site Plan Name: Block No.
Project Name: 6PEL-.Eiz pag?ln=— U .6
Additional work to be performed underthis permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters=Wiridows/Doors' 4
_ Electric _ Plumbing _Sprinklers _ Generator i '. .y .'!Roof : Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ o7oZ9d9•VL9
Sq. Ft. of First Floor:_
Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
C0NTRAGfOR:
Name .Ar-w2Y
Name:
Address: / 0701 S.i*;; Di
. LOT $qy
Company: '..
City: EJ46EJ4 (3EACAe+
Zip Code: 34957 Fax:
Phone No. $Gi�2ZZ-J77 7
State: R.
2�2Z -85i9
City.: ?Lr,,.,JG;suicrr.^;
'i : .^ ._:`t-
Zip;Code,'
&.
Phone'No"
d State:_
� Fax:"' .
E-Mail:at-GC:IIerZ72 �ONp41L.�Mf
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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.
LQWffE8K14,= A S Q_N SIT, R RM
MaM
MORTGAGE COMPANY:
Name:
Not Applicable
DESIGNER/ENGINEER:^' _ Not Applicable
Name: M/A aes 'E4ue2nMIA&o C►o9,f'
Address: atl310.6. Diyia
fddt/i
Address:
city: 15 VA—W
Zip: 3 Phone Zi/-Si4ri7-
State: `
ysoq!T
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: " Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obta(q aypermit 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 Coun_ makes no representation that is granting a,permit will authorize the permit holder to build the subject structure
whicr is'in conlictwith•aq applicable Home Owners Assocation rules, bylgws or angcovenpnts that may restricfor pfo4ibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In considefation 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 andaccessory' uses, to anotber'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
WIT R L ER 0 ATTORNEY-BEFORE-RECORDINC•YUUR NOTICE'OF COMMENCEMENT.'+--
S' nature of O ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder '
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF iy
COUNTY OF
The fo going instrument was. acknowledged before me
The forgoing instrument was acknowledged before me
this day of �, ��•• J , 20.j7by
this day of . 20_ by
caekeevl Geller
Name of pers9fi making statement.
Name of person making,statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati n
Type of Identification '
Produced (�11` J ir .
- Produced
p.
(Signature of No Pu ic-State of Florida) V
(Signature of Notary.Public-State &f Florida
Commission No. :'i'•°'•°."': AUDRE$1)IMPHREY
Commission No. • '."(Seal) ,
MY COMMISSION # GG 3008117
,< EXPIRES;
ed Tlcu Notary
Gc Undentdters
° .•,
..• ". •.
..
"
REVIEWS
PLANS
.VEq,ETATION';,
SEA,TURTLE.•
MANGROVE
R
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW-
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19