HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COmpLETED FOR APPLICATION TO BE ACCEPTED
Date:. I� ��- Permit Number: g?�®��`
RECEIVED
SEP .3 0 1010
Building Permit Application Permitting Department
St. Lucie County
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
PERMIT TYPE: .
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Property Tax ID #: JcC�p ���' l� - C7(�l� -� Lot No. TI I
Site Plan Name: Block No.
Project Name: '36LJ"vk
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3_apO
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
C}, N =�R LESSE
. • � R�1C� OR
NamePAPrRV� Q)KOOKS
Name: bmli�j
Address: 'e'S5 7 C-of�3LJI- c;TbN �-
Company:`f`tgA1 .wZ czms SOUR
City: cok - p► (RcJ% State: R,
Zip Coder I `�� Fax:
Phone No. 2-0-7 S7� Sr
E-Mail:
Address: 2073 SQ- l- ASN- I rJ=tJ S t
City:!MVV _T State:CL-
Zip Code: 3��g7 Fax:
Phone No 772 6 31 7R96
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 50 Lpi P.1 C, 3 G-M p, I (, , U 1-\
State or County License C-VC- S 6683
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.
DESIGNER/ENGINEER:
Name:
Address:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
.City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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
WITtIkYOUX?LENKR, R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF
OF toc`%q-
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Q.Ce day of 20A by
this'ci� day ofy p c N\ 20 V� by
—�
\
Q V N X TC' % t— .
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced L Q L
Type of Identification
Produced �L L
(Signature of Notary ublic- State of Florida )
Commission No.<i<r DEANIOMMI GIVENS
(Signature of NotaryPublic- State of Florida)
Commission No. G'<T
MY COMPISSION # GG 022023
= r :o; EXPIRES: December 1 B, 2020
`
NNA MARIE GIVENS
ci°•• = MY COMMISSION GG 022021F
; '•,;oFF��P' Bonded ThruNotarypublicUndomiler'
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Rev 2/7/19