HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFJ MUST BE COMPLi, _`, 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
PERMITTYPE:
P.RO`PaSEQIN_PROVEMENT LOCATION:
Permit Number: Aul • 0S�
RECMVED
Building Permit Application
P&MItting Department
5t. Lucie County
Commercial Residential_
Address: J 15 0-i- . m i rA.m.Qi1'- A yt-,
Property Tax ID #: _� - (Q.0� Lot No._ a cP
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OFWORK: ' ''
CO.NSTRUCTION'INFORMATlON:
Additional work to be performed under this permit -check all that apply:.
Mechanical Gas Tank _ Gas Piping Shutters
X Windows/Doors
Electric Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 1146Q
i
Cost of Construction: $ 1 *701 lg6 Utilities: _Sewer ,Septic Building Height:
OWNER/LESSEE:
.CONTRACTOR:
Name
Address:33(�b lot
City: State:_
Zip Code: '1-? LA (0 aF6 1)-3
Phone No. �`1 �' i-tS 3 1-1 3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: VJos �yus�e�t Q
Company: 1Q5\z� LL.C.
Address:3300ol
City: �— State:
Zip Code: 0
Phone No 17a-t-k,&3- -Lf i �.
E-Mai �p
State or County License C,C, �5`77
it value of Construction is $ZSUU or more, a KtGUKutu Notice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
fSUPPLEME.NTAL`CONSTRUCT..:�LIEN LAUU�INFORIVIATIONi
_
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: -Z Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ?L Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 Count 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
co mmencIn work4or recording our Notice of Commencement.
Signatur of wner/ L ssee/Contractor as Agent for Owner
Signature of Cofifrac or/L ense H lder
STATE OF FLORIDA
STATE OF FLORA w
"
COUNTY OF &1,z
COUNTY OF_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this .day of 20j by
this 2 day of 20 by
Name of person making statement.
Name of person making statement.
Personal) Known
y OR Produced Identification
Type of Identification
N D'ONOFRIO
, ;, q E%j6fXj=2
Personally Known ��•t�gdu�+��t�f�tg�237558
Type of Identification �= M
°;, EXPIRES: August5.2022
Produced
Produced "' NotaryPubrtcUnderwiiters
r �
L
ignature of Notary Public- toe
G
I r a re of Notary Public- State of Flo •d' )
23%S@
.�, :+ MY COMMISSION #
Commission No.I1 EXPIRES: August5,2022
POF ondedThruNotarypublic
'SPAYpu• a�� �ENVONOf
n6e�Fift�i3i ion No. �`75`'' �."NIYCOMMISSION#G
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:�� EXPIRES: August 5,
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SERTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 9/26/18