HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO DUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / 9/12-- 6 Gl 9
Date: Permit Number: �) '
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
ENT
RECEIVED
Building Permit Application " DEC os 2019
Permitting Department
St. Lucie Count,
Commercial Residential X—
Address: `6(8�6 c � i�CicCe CUB �vCk/c�:�n56� luc Fl, NGNck
Property Tax ID #: �OC7l+b- Lot No. 3z
Site Plan Name: Wq �e �, C�U`� /�� 1-7m1 N, Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
XElectric —Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: c''r Sq. Ft. of First Floor:
Cost of Construction: $ �� 1,1l 1l`i . (2)(::) Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: A 7-rq k kOC
Address: 6 I�Ji IcI 4 �v of 0(%
Company:} ko, G n-- S Si
-ems
City:i O utnsoc-l�S1an4 State:
Zip Code: 3qclual Fax:
Phone No. Q(0-6 r7 5' U63
Address '60 McA WoC2, N. -C—
City: �eT Viere-e'. State:
Zip Code: -�u q(� Fax-11Y446-1q 31
Phone No --1 la L4(nq a(o(n
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
KI 4�IRil°Derci4 0.i gMGi
, CAS
State or County License C 05 tO (P 3�
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.
�R E , RIVAL CO��NSTR CTI�ON LIEN LA1%V IN'
FRMgTtON:
v '`;
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing=_ work or recordine vour Notice of Commencement.
Signature of
as Agent for Owner I Signature
STATE OF FLORIDA STATE OF FLO IDA
COUNTY OF� I u6,PCOUNTY OF, I kC, 42_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 25 day of 610VervLlX'e 201Q by I this z5 day of it0 ✓Cm6 A, 201'? by
Name of person making statement
Personally Known,_ OR Produced Identification
Type of Identification
��Afk Zrallo-critL
Name of per making statement
Personally Known �/ OR Produced Identification
Type of Identification
AA"
(sii5 gnature of Notary Public- f
..A"L&42Af
(signature of Notafy Public-S
rb V%f
Commission No. S +�
I�o�ry PuDlie Stale of Flontla
hi jSarah Blysione
mmission No.G&5W S
Notary Public State of Florice
f 'glj;arah Blystone
r Commission
p
My Commission GG 381295
or
GG 361295
EX048 DW42023
�lor
Expiros 08/242a23
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW
REVIEW
REVIEW
Rev.8/2/17