HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O Permit Number: 1%
RECEIVED
OCT 10 2019
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED] M PROVEM ENT LOCATION:
Address: In yL� �L-e ,>. 36 - PiEWC A • YYISZ
Property Tax ID #: .?yl1 Z - 4e69- 6?6(o OCR Lot No.
Site Plan Name: f�c1Q74,_1yE�P �S'TATES' 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 IPiping _ Shutters dows/Doors
electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: /3 3 Z Sq. Ft. of First Floor: Lill -
Cost of Construction: $ O . k060 Utilities: —Sewer _Septic Building' Height:
' OWNER/LESSEE:
CONTRACTOR:
-Name TAntDi2/AJ�C , .Sl-
Name:-Ddy//? VDA.&
Address:
Company: /i4s.t 61- �.JiEQGy21S 4S /��.
City: " C-1 ru State: ,&
Address: /00 W lt_ll aSO�4 LEAS lam•
�`1
Zip Code: 3qqQc Fax:
City: �-,fZJP►TC0 Stater.
Phone No. 7:Z2 i
Zip Code: Fax:
Phone No (A / . �7�� -'7i
E-Mail: 7aEsT�i_�4. AA/L. Ga.--L
Fill in fee simple Title Holder on next page ( if different
E-Mail ZS7'+S��Gi►'t� 1 L. GO�`�
from the Owner listed above)
State or County License ._t.
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.
. w
SUPPLE`MENTALCONSTRUCT)ON LIEN LAW INFORMATI,O{N .
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 M EMENT MUST BE RWORDED AND .
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. 1FYOU
!KH YOUR ENDER OR AN ATTORNEY BEFORE RECORDING YR OTICIOF C M ENAG, CONSULT
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF ORIDA „{ (,
COUNTY OF STATE OF ORIDA�al� -w—t
COUNTY OF .
The forgoing instrument was acknowledged before me
The forgoing instrum nt was acknowledged before me
this (e� day of C'-f 20Gby
this �brday of P 2011 by
S�dl���+tiiC�S�f
Name of person making statement.
Name of person making tement. /
Personally Known A"" OR Produced Identification
Personally Known OR Produced Identification V
Type of Identification
Type of Identification
Produced
ProducedtrC.IDL
( I na a of NotaIN�.i
(Signature of Notary Public- State f F rida )
JOSE TAPIA2�om fission No. Notary Pub ' e I to of FloridaCommission
CommisMA i �G
Nor .7wrr.►� (Seal)
215487
My Comm._ Expires May 8, 2022
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Rev. 2/7/ 19