HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �f s
Date: Permit Number: ! m ® (J
`' 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 APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Legal Description: 1 1 pa
Property Tax ID #: oC dC c—)s ; 1 Lot No. s
Site Plan Name: r �^F Block No.
Project Name: Jamb f
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
S4, aq I r c rocs r
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t is permit — check a apply:
�HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing []SprinklersM Generator P!rRoof Roof pitch
Total Sq. Ft of Construction: V 1�1� S . Ft. of First Floor:
`t
Cost of Construction: $ �1 I UtilitiesInSewer OSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: n
Address: S�� �� �� �Cf�
Company: r'D
City: State: EL
Zip Code: Fax:
Phone No. G
E-Mail: 0
Address: - I
City: Stater
Zip Coder OR- Fax:
Phone N � S
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mailr 1
yflifnitl
State or County Lice se: Q
it value or construcuon is -sz5uu or more, a KLLUKutu ivotice or commencement is required.
SUPPLEMENTAL CONSTRUCT N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: V Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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,yv,ork or recording our Notice of Commencement.
Signature wner/ Lessee/Contractor as Agent for Owner
Signature of Con actor/License Holder
-�
STATE F FLCOUNTOY
ORIDAS1
STATE OF FL
R�
OF lr�
COUNTY OF
The r oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this' day of C 20.,�k by
this � day of 20 071 by
Un tosS
0 n W ASS
Name of person aking statement
Personally Known OR Produced Identification
Name of per n making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
emo
(Signature of Notary P
(Signature of Notary Pub Ic- ate of Florida )
otary State of Florida
��dY "�:.KeIsi.M---'--
Commission No. o11Commission
Myc� n GG 308996
iii/2023
No. r 11
ary Public St t�Floridaxpirs
c
= Deena M Sabella
My Commission GG 229100
- u- Expires 06l14/2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
NOTICE OF COMMENCEMENT
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Permit No. Tax Folio No.q)-N�
oAamm
State of Florida County of St. Lucie
t?rn�m�
ID � 0
The undersigned hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, F
2 3
o p c r-
o m N Z A
the following information is provided in this Notice of Commencement.
; o n
cn r
LenSr"rXK6T erd tre -addre f available):
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General description of improvement:_ 1) I 1 YyU
n
Owner inf r a to r Less e i form Mon if the Lessee contracted for the improvement:
c
0 --1
Name
0
0
Address
z
Interest in property:
Name and address of fee simple titleholder (if different from Owner listed above):
J oip V
Contractor's Name: J _
Contractor Address: F.Phone Number:
.h ay ��CC. Fly �i ISM
Surety (if applicable, a cop of the paymen bond is attache°�: Amount of bond: $
Name and address: Phone number:
Lender Name: Phone Number:
Lender's address:
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided by Section
713.13(1) (a)7., Florida Statutes:
Name: - Phone Number:
Address:
In addition to himself or herself, Owner designates
Lienor's Notice as provided in Section 713.13(1) (b), Florida Statutes.
Phone number of person or entity designated by owner:
of
to receive a copy of the
Expiration date of notice of commencement: (the expiration date may not be before the completion of construction and final payment to the
contractor, but will be 1 year from the date of recording unless a different date is specified)
- WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED
IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13, FLORIDA STATUTES, AND CAN 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 COMMENCING WORK OR
RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of perjury, I declare that I have read the foregoing notice of commencement and that the facts stated therein are true to the best of
my knowledge and belief. _
(Signature/ Owner orYessee, or Owner's or Lessee's Authorized Officer/Director/Partner/Manager
(Signatory's Title/Office)
o,oy P& Notary Public State of Florida
? Kees! Moss
y c My Commission GG 308996
�'Fai F�ov` Expires 03107/2023
STATE OF FLOR DA -
COUNTY OFF ,(c
The foregoing instrument was acknowledged before me by means of�l physical presence or ❑ online notarization this day of
20�by M(14� YjMe c o is personally n tome or has produced as identification. J
[NOTARIAL SEAL]
(*�wivw
NOTARY PUBLIC, State of Florida