HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COI1,
Date:
:rED FOR APPLICATION TO BE ACCEPTEL,,
Permit Number. C;b&N5 -
RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
(-'c)d.e I✓ MAY 2 71010
Building Permit Application PeSttt'U9e� rtyent
Commercial
PROPOSED IMPROVEMENT LOCATION:
Address:9%OG , 5r, en ccgmr `JD/ .yvi 90 7
Residential !/
Property Tax ID #: Li SOZ- 6 26 - Q O 70 - C>O ( Lot No.
Site Plan Name: Block No.
Project Name: .,Co114,- 2&\1
DETAILED DESCRIPTION OF WORK: n I 1
i !2 4 S
V200w. et,NC�plkc� Ki fcic%.� Cc,lal +ct!syv��•t �)ae f \`�. au
t(Ze v..&v4aL /a w -cA o ASS �..v-c , f Zeu �r k 4 - c lie J �' P 1 /I vS �
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
� Electric _ Plumbing _ Sprinklers _ Generator
Windows/Doors
— Roof
Total Sq. Ft of Construction: S 4 4- Sq. Ft. of First Floor:
Cost of Construction: $ �� Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name D clui eo�iu
Name: Qxctr k s F 3
Lj r�
Address: 1(03 Cd�mc� 1l
Company: ���is b�rN � r��
City: ?,W4 State:
Zip Code: 3 -3 9 9 S- Fax: q
Phone No.,R 4 % - 6 61 ^ Gq 8,(
Address: ��S�d S Oc�.� (�r Vt� f76
City: �u�5c� � � c State: r 1
Zip Code: 3 yQ 5� Fax:
Phone No 305% / 4/2-' /.57G
11
E-Mail: ok C1h -Krce- iD A too - cpm
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License CGC o3 sea G
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 CONSTRUI I ION LIEN LAW INFORMATION: -
DESIGNER/ENGINEER: _Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 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.AIIIATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
a�4/
Si nature of ner essee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /
STATE OF FLORIDyy
COUNTY OF
COUNTY OF7 - o�GGc2—
The fo oing instrument was acknowledged before me
this/day of�� 20x� by
The for ing instrument was acknowledged before me
this day off 202-/ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification !//
Personally Known 7!�o OR Produced Identification
Type of Identification
Type of Identification
Proddu/uceed tad /% � ljyL-4
ProducedZ� 2%.Z.
�/�%ZG
(Si nature of Notary Public-Sta f Florida I
(Si RyfnGture of Notary Pu lic- State of FI Ida
"� WILDee� T. KELLY
� WILLIAM T. KELI `
Commission No. ��"
MY CG M1S 60GG277615.
Commission NO.
OMMISSIA"4""
�+r y EXPIRES: November 18,2022
MY
fi' EXPIRF,F. N^vewh"' �k '�<%I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev. Z/7/19