HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
COUNTY' )AN 2 2 2020
Building Permit Application permitting Department
St. Luale 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: Rz'IQ A064%17C'k1
PROPOSED. IMPROVEMENT LOCATION:
J
Address: ,U Qyw_e-yi CT
Property Tax ID #: I_` I `7o ' 0i31: - oc_x-3 ` e, Lot No. Q
Site Plan Name: "MefSGvk no - 7'0h Block No. is
Project Name: ���LTc%O 0 'rT Gti-
CONSTRUCTION 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: $ IO,C Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE
CONTRALTO R �
z�n
Name
e0'S CAOL
Name:
15OavL
Address:12.2 cju'e_,eH C"7k&rl
Pta, C-T-
Company:(74N4_1Tai:7fKJk
City: j V sole 1�6
State: ,
Address/3 5'/ t ;a 4 cw% G 1.
Zip Code:34ict ail9 Fax:
City: 1-r 13 `ercle-
Stater(.
Phone No.
Zip Code:3g9y9 Fax:
E-Mail:
Phone No 3 l 7
Fill in fee simple Title Holder on next page (if different
E-Mail aL1 erS " CtG N
WI
from the Owner listed above)
State or County LicenseG-3L 12K /!S/
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.
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SUPPI.�N�EN1"Al.¢.C�?N�.Ti�U
r>TION�LI�N'LAaW�NFOl�MATI�►N
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DESIGNER/ENGINEER: _
Iy.Qt Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:Fv%e- 4�n4iyier—f o.
'cS11 Vm
Name:
Address: —� I
Address:
City: Orrlmyw4s
State: L
City:
State:
Zip: Phone
21 L
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 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."
Sig ature of Owner/ Lessee/Contractor as Agent for Owner Sig ature o Con ractor/License Holder
STATE OF FLORIDA I I , C ' .� �COUNTYOF STATE OF FORIDA l � , -
COUNTY OF o�^�`
The forgoing instr nt was acknowledged before me
this day of C. 20 2D by
Stt1
Name of per n mak ng statement.
Personally Known ✓OR Produced Identification
Type of Identification
Produced
.ham— d �T' -'1► q ��Q ('
The forgoing instrument was acknowledged before me
thiis7-7- day of 20?� by
l 1 ny-14
Name of persoA making statement.
Personally Known '---OR Produced Identification
Type of Identification
Produced
ture of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
9�jjq�� KRIST�€�� MIRANDA, 1 q7 j K STIE F. MIRA
Ission O. .���ra��4 �`iir���4
ate of F on - Notary Public Commission No. �o.. L�: of Florida Notai
Commission # GG 197974 _� �_ Commission # GG 1
=a My Comm_ Fxnirws nR_9d_7n99 = My Comm. Expires 03
Bonded rhrough q��iina�� eonaea inrougn
REVIEWS F ssoci ti — — — -- JPLANS VEGETATION Am ri n s is ion of N
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED