HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COV,,,ZFTED FOR APPLICATION TO BE ACCEPTEL
Date: T 2-14 Permit Number:
61
— __•-- - - - Building Permit Application RECEIVED
Planning and Development Services SEP.-24 2019
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial b Residential St. Lucie county
PERMITTYPE:
PROPOSED IMPROVEMENT LO ATION:
Address: 27 D 0 Ay 2 ?/ �e-rL" "Z 4 9 4 6
Property Tax ID#: /49-1 -5:01 0/1q Lot No.
Site Plan Name: Block No.
Project Name:
DETA L D D SCRIPTION OF WOR
A"L, I/J� �rtor f-�N00oti1
CONSTRUCTION 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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ! 5-O Dc) Utilities: —Sewer _Septic Building Height:
OWNE-RILE-SSEE: CONTRACTOR:
Name Lucre 6DwQ4W (3.D.<_C_ Name: jeAty in+VSoy
Address: 23ap 1/+ra Niyl Ave of Companyiau S. ';'Lu•r:'+ t[out��,� '1 noz-L
City:�re5e State: .,.
to d f �t Address:. 2 S o 111 fv i ti Q V
Zi Code: 91 Fax: '��•'"
P /1 _ CityA.._, - ip, f;;.+ e r.iC 2 Stater
Phone No. -77 1 - 4 6')-- 1100 Zip Code: - Lr 11 8 Z » Fax:
E-Mail: Phone No ? 7 1- 6 2 // D 0
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) 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.
Not
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of ner/ Lessee/ ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 3r.L.4eIE
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _La4 day of 5eo 4B,KbQ ' , 20/17 by
a
this _ day of 20_ by
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
Produced
(Signature of Notary Public- a xtt•E,)oMEWS AS.BO CKEL
�?;scommission#FF979475
( gnature of Notary Public- State of Florida )
?
Commission No. �T979 f letowVjPn15,2029
f mission No. (Seal)
j4t•' sondwd m Tray Fein InsuniftcG800-0
7�
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PLANS
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DATE
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DATE
COMPLETED
Rev.2/7/2.9