HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: A fr/dk 12614 Permit Number:
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
U�l� - VUL9 Property Tax ID #: J+2(J3 - Sn�- 8660-ono Lot No.
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction: 280
_ Gas Piping
—Sprinklers
Block No.
_Shutters Windows/Doors
_ Generator VI
Roof �T Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ I.S. AA b _ C%n Utilities: —Sewer _Septic Building Height: 1 D '
OWNER/LESSEE:
CONTRACTOR:
/�
Name RICAMD— 6�S-S0 - ....
Address: E- ]3' Et�fy -A1 j, '
City: 1 ff 9JF-0 !� State: 4L
Zip Code: 2,?2.Q6/ Fax:-/2-5-MQ, 4170&
Phone No. 772 - 154 3- /- 2 24
Name:IAAIL)c
Company: AINACCA PAA%5m nr.TTn1,l
Address: Adt L3EJ VE nE1tE 00 SutTB 7
City: W EST (-ALM 15 EAL H StaterL
Zip Code: .311466 Fax:
Phone No -SA 1- 2 2- 3A 90
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailmen t AL k E Ypest s;u �(o�f///L..eoM
State or County License ( (�I 13 4JF
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. v5 �J LP
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERIENGINEER:
Name: NAgLAAhJ I)-
Address:406 REL.Vco@kE
City: wr&k gAm OgAn4
Zip: 2a 46S Phone 5 A
_ Not Applicable
EkA
RD 5+7nE7
Stater_
1 — 24el — t2 2
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 andcovenantsthat 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 Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF S'T. /ijcrA�- llaewi`51
COUNTYOF Sk. uir.jfr
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this , pL day of u aw 20 aC by
A/AO-v .1E.ukiu S
this 9k, day of AinigS& 2QA(, by
%sir/! ak,
Name of person making statement.
Name of person making statement.
Person ally,Known ✓ OR Produced Identification
/
Personally Known OR Produced Identification ✓
Type of Identification
Type of Identification
Produced,•'
Produced aTAT li0 A- ala
,y
COMMISSMN /GBc'8863
EXPIRES 5 in
'I " '' ary Public- State of Florida)
(Signature of Notary Pu of lllba ft A�T911110L� ,
G raM0 Ayala
s i(Seal)
Commission No.
e
s EXPIRES: Wavy 5, 2023
jgry
REVIEWS
FRONT
ZbNING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address:
Permit Number: a1 10 V inL��'
zo
Building Permit Application
Commercial (, e9 Residential
Property Tax ID #: /itz 3 SO 3 -ODBO -- eco - Lot No.
Site Plan Name: 007 19Gi7R 436a Block No.
Project Name: no900K 1-3,Oa ALE/-
It
( �s
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank
,�lectric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
(h/`S
_54as Piping _ Shutters -Windows/Doors
Sprinklers _ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Pitch
,OWNER/LESSEE:
CONTRACTOR:
Name
1016)l C04 0rh1A11U OG
Name: 34-4S k-e- 14
Address: Qp Al. 4 1/a
Company: VIA-e—tLLd C-7_4h� Lj�L
City: a State:FL,
Zip Code: �_ Fax:'CAI-0
Phone No..�77-72: 5 6Y- gS5 3
Address: 12A�89As2 8 Aaa-i f
City:� Na aeA..e State:
Zip Code: i,�(y Fax:
Phone No i291>21 9V -
E-Mail: 91CA,4,<z3 k eeWtoHmckeate l
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail o I,'le
State or County License 5 C u8.-
C 61 C 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.
SUPPLEMf-NTAL CONSTRUCTION LIEN LAW INFORIVIAT10
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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."
%�✓1
Si a of ner/ Le-see/Contractor as Agent for Owner
Signature Contractor, Holder
STATE OF FLOfjIDQ
STATE OF FLORIDA/
COUNTY OFr�F.'L1tC le
COUNTY OF IYI(Yjal aVa
The fggr�oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisn day of 1' (f}� 20ZDby
this�Lday of 20_,;0by
��oA � e lju,✓
(urtl� 69k o
Name of person making statemen .
Name of person making statement.
Personally Known X__ OR Produced Identification
Personally Known / OR Produced Identification
Type of Identification
Type of Identification
Produced
I (aaz�,�z
Produced
9�/A�
(Signature'of Notary Puff '
(ig ature of Notary Public -State o
NoteryPub4eSYateofFlOrldo
L+�
„x�•q Nclary Public State 0f
AP �` annahKle,,2
Commission NO. Rlcha�eadltne9Jr
Commission No. I iycommissienGGi
9p,�p�a E�I�90SI29R020960714
pV Expires 111061202J
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
R—e—v.7/7719