HomeMy WebLinkAboutBUILDING PERMITAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
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: G! C/A e U — VA
PROPOSED IMPROVEMENT LOCATI .
Address: 3p5. F\ VE `ee)o bime PacI..JCIe-� At'lO►'�- 34c(JrQ,
Property Tax ID
Site Plan Name:
Project Name: f% 1 IDM R 6S7 Qe*XC-
Lot No. S-
Block No. 3
I DETAILED DESCRIPTION OF WORK: I
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:
Cost of Construction: $ a.R ` 5_�9'kX
Sq. Ft. of First Floor:
Utilities: _Sewer `Septic Building Height:
OWNER/LESSEE:...
CONTRACTOR:
Name KCVid1 C. Wtnae,C
Address: 6 ���, �Akrues+ R tAae. U);��
Name: MpaeS L, 1AII,am5
Company: AQ Ak
(,(
City: Lrt L< pew--Ij- State: f
Zip Code: 14-- h. • Fax:
Phone No..'? I _ wag- c-13a4
Address:
City:r&?Oj`* State: �L .
Zip Code: zqq g3 Fax:
Phone No'j')&-(,oii-70,'S-0
E-Mail:oQacg,&ak6ue,ad,%Q,,C;�I-com
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail d(kkep
State or County License CftC 18
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 CONSTRUCT! N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: , Not Applicable
Name:
Address:
BONDING COMPANY: ZNot 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
11
"WARNING TO OWNER. YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPRtJYEIMENTS TO YOUR PROPERTY_ A NOTICE OF COMMENCEMENT MUST BE RECORDED AfJD
POSTED ON THE 9oB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR -LENDER OR AN ATTORNEY BEFORE RECORDINC YnUR NOTICF nF C nMMF'N[`FMFNT
Signa f er( Lesse Contractor as Agent for Owner
i ature of t or/u s er
STATE F LORI -
STATE OF FLORIDA -
COUNTY _ '�' �. VC �e .
COUNTY OF ��' L ()C I r
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20,:U by
this 0J& day of _Zf'"()A'/2 20J 1 by
y1VVW %A
W L L tlZ11z-�
Name of person making statement.
Name of person making statement.
--"
Personally Known ..`` �� c� l+ziG 1 N S
° a I 3 �i3
Personally Known 1/
y
Type of Identification =
yp =. �a Commission # GG 956362
+u�Pe
Type ofldentification �tPpVP�B i ALICIA HIG I
Produced Commission Expires
Produced ?a° �� Notary Public -State of Florid
�°„ter` February 09, 202a
= mission # GG 956362
OFF�°P�! My Commission Expires
/nnm` February 09, 2024
(Signature of Notary Pu�b-llic- State o a)
(Signature of Notary P�1ub tate of Florida )
�J
Commission N (Seal)
Commission No(�� �, (Seal)
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Rev. 2i 7 19