HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: Permit Nu /2---03 �O
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Building Permit App ication DEC 18 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential `/_
PERMIT TYPE: f'y7'
I. PROPOSED IMPROVEMENT LOCATION:
Address: A55- 52o-v-5 G+.
Property Tax 1D #: -2 i k cl — Sbl - 0011- 000 -3 Lot N
Site Plan Name: Nvi-e Vi54k Block
Project Name: 't>2.SaVdi S
V)s+6tj k a LGe ssan a�--d c w cr--+e- s ULb 3 s x 30
""c f4-'L f a I / bt./�
-1212
CONSTRUCTIONINFORMATION:
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric —Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: I OSO Sq: Ft. of First Floor:
Cost of Construction: $ 151 2-00 Utilities: =Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name W + Wog yv� D-0- $ amgs
Name: N.iCXa t,l
Address:3oUkg C-roc.icc-4 W"
Company:--&cKSQvx LutisM��ti�. Csrukla.
Address: 130') 3 53` k C-F' M
City: LAY-e W C4A-L^ State: R-
Zip Code: 33+Lp-1 Fax:
Phone No. SQ I • q-3Q • 1+?4 -
City: �Nesj_ oa[Kro Re-A� State: FL
Zip Code: 33`1-0 Fax:
Phone No g'Qi•3$Lo.3$3a.
E-Mail: +bi1\iCp@_oLo1•L4Ny-,.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0[LQCS' v+ c -y. c,vc,4�-@ ycc4 ao. caM
State or County License C&G I SI 9 1 U 0
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.
M
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
Name: $ecV+o I em 4-i-errh
Address:U05 Wzs+ N<wYau AVM
City: he Lav-d State: FL
Zip:Phone
FEE SIMPLE TITLE HOLDER: v Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
✓ Not Applicable
BONDING COMPANY: v Not Applicable
Address: Address:
City: City:_
Zip: Phone: Zip:
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 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 concurrencV 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 LENDElk ORAN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Less /Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLO I A
COUNTY OF Pa(W, Q-e-e�-�^
COUNTY OF Ct rK fi)-•
The forgoing instrument was acknowledged before me
The fgrgsing instrument was acknowledged before me
this JVday of NoVe her ,20 19by
this lK dayof Noyumhev ,20(l by
W i MOLAl- D e Savt tis
hti GkA_J. l
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 IetrY PuDAc
Produced
WXYPubic State of Flaka
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Expires 08r20r202a
Bonnle Gomez
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(Sign [ of N ry Public- Sta e o on a
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
1(
RECEIVED
DATE
COMPLETED
Rev.2/7/19