HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4V Permit Number: 3, d 01' 03A1
Building Permit Applic ion
RECEIVED
Planning and Development Services AUG 19 2020
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Re --
PERMIT TYPE: ,v o ies, �, \ ` a YV\ k.,
PROPOSED IMPROVEMENT LOCATION:
Address: 5d0
Property Tax ID #: I-i`�St31:1 - t- z1b\- M-U-2 Lot No._SQr�
Site Plan Name: e� 5\jPvrA Block No.
Project Name:
DETAILED DESCRIPTION OF WORK.,t. w
C�c�er c-'vt- lvo Nrz-,(-- 7� z � re-& ` R--%o '_ 5M `? S \
CQNSTRUCTION INFORMATION
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: $ I a a d . it d Utilities: —Sewer _ Septic Building Height:
OWNER/LESSEE
'
CONTRACTOR
Name o S �.J
cw ev,-
Name: N�Q,e
Company:
Address:3np N
City:'S261Seu--� ?7)CsAc��
State: t A-
Address-�M-?3
Zip Code: 3yS5__1 Fax:
City: f'C '�XeSL.-c_
Stater`
Phone No.
Zip Code: Fax:
E-Mail:
Phone No aa`3
E-Mail Rwc_skvc'�O u C.,
Czn. cwts • r`
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 CONSTRUCTION LIEN LAW
INFORMATION z
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: aSe�\c>�e.
_
Name:
Address:
City: State:
Zip: Phone:
Address: Lr-n
City. o r State:'- L
Zip:'3y6q� Phone C - - - % t
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 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."
411,
Signature of Owner/ Less/contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theforgoing instrument was acknowled efore me The f ,Ming ins u ent was acknowledged before me
this day of ` �� r� , 2 y this
day of 26by
Name of person ing statement. Name of person making statement.
Personally Known O Produced oduced Identification Personally Known FOR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Commission No. (Seal) Commission No. (Seal)
' V P '•.. _ M
`` i� r��p: tiY PREVIEWS FRO: �`O�t'�'dnPLANS VEGETA-��sE,���:;g
VE
COU o FtE;IF�IrREVIEW REVIE s`. REd6 ior ec c ro_g 281062
DATE 8 nded through
RECEIVED
DATE
COMPLETED
ev.