HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICADLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE
4
Date: �' i Permit Number:
RECEIVED
zzm�
FEB 2 0 2019
Building Permit Applicat (1 Lucie County, Permitting
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 Residential X
PERMITTYPE:
PROPOSED IN.PROVEMEN,TaLO.C:ATION,", .. °
Address: Q-1 % W e41eS F21UA . Jcy-\s n ee-aCh, )�-L 3aG5�1
Property Tax ID #: g5neZ- 5 Q 1- ILA (,S " 6 Go - s Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION
V 1`J`4W Z A &reX,ht AA X h AAA 914 11 T/7 (11 A rd'A1.1 P /. V o0 I k-
I�CO'NSTRUCTIO'N JN �.�..QRMATION:
.£..f. .3 . .
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: $ 1001 Utilities: —Sewer _Septic Building Height:
° W ER/LESSEE t "� jSS^b £ N
.h
CONTRACTOR:
NameCtiris io{1e:t d- Pa+r�`cjf, DUYGP.SS
Name: 68cc,Y-. tAahs
Company: Ad-Q-,1 ( y\4WCEC-%
r
Address:
City: �eY-XSCAN gen'c.h State:
Address: 64-7 S. (�� ►-t
��riy�
City: JP_r'S-Cry lkac►-1
State: -!a -
Zip Code:3tjes') Fax:
Phone No.
Zip Code: 'Z!Jg61 Fax:i-ggqo
E-Mail: -
Phone No '1'12-22�i- Ct U3Ci
E-Mail Marla in, J- ITV - Loy,
Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
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.
SUPPLEMENTAL CQNSTRUCTION LIEN LF,W IIVFORMATIO:N
".l
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 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 recording vour Notice of Commencement.
C
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA ,
COUNTY OF
COUNTY OF --
The forgoing instrument was acknowledged before me
The for oing instru ent was acknowledged before me
this day of 20_ by
this day of 20JA by
Name of person making statement.
ment.
Name of person mak711
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
•
lz�
(Signature of Notary Public- State of Florida)
(Ign ture of
Commission No. (Seal)
Commission N
1Y Pii`•. GAIL P. FARRELL
,`: Notary Public • State of
lion
.: # GG 271N
:
My Comm. Expires Mar 21, 2023
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DATE
RECEIVED
DATE
COMPLETED
lev.9/26/18
bE _S1_G N E—RTENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 additlons,
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
Notice or
Signature of Ow er/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF /� N` ri COUNTY OF ( c�
The fo oing Instru ent was acknowledged before me
this day of 20 ] , by
Name of person m=uced
Personally Known Identification
Type of Identification
No.
REVIEWS
RECEIVED
DATE
COMPLETED
Public- State of
The forgoing Instr ent was acknowledged before me
this J* day of 201A by
Name of person making st ement.
Personally Known 7OR Produced Identification
Type of Identification
Produced
re of
GAIL P. FARRELL
Notary Public • Stag ofmortd&
GAIL P. aFlorldla
Commission N r ion I i74�¢j°+/
W10021v Notary Public - Stat�.R My Comm. Expires Mar 21, 2023
Commission p GGended h + I nal ISOR PLANS VEGETATION SEA TURTLE MANGROVE
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