HomeMy WebLinkAboutBuilding Permit Applicationl//
All APPLICABLE INFO
,MUST BE COMPL�.:LD FOR APPLICATION TO BE ACCEPTED J )
Date: 9- L9' 1_T Permit Number: p(�/�,Q' -1 c ✓01
vece rev
Building Permit Application N%
Planning and Development Services per��tt�°U�p
Building and Code Regulation Division St.
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: ffe-vj RM-1 /Se jam/ ex1'&hh- hAte
Address: 6L3/ / 6;�LS1- �GGt_o P'n2S
Property Tax ID#: l3/a—,-00-0133-000-7 Lot No.
Site Plan Name: aaQAQ Block No.
Project Name: p6t1'L
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: $ (n
Sq. Ft.. of First Floor:
Utilities: aSewer _Septic
Building Height:
TRACT.
Name cif e J lei,(,]( ?af-t
Name: 19-n- rQ 17n� f' S �1d
Address: L'S-3l/ L6csl Z2/-z6 Pik 6/.
Company:,{YYv)O�?'
Address: 64 % Gi
`�i'r'' State:
City,l`�:,� , rc `� -
Fax:
City: State:
FC
P;hone,No.
Zip Code: ,� a y Co �7 Fax:
E-Mail:
Phone No 1 7Ja -3 told �'a a� 0
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.• 1 q
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. l
it
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C Pp�ElVI A 1C� F U Ifl EAW iN OF IV ATI �,
.., .. . , .��r ,
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: Not Applicable
Name: — err Name:
Address: 1 lnvU Address:
City: �?6 A- State. City: State:
Zip: 17 Phone 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
is in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict
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.
r
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."
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—
Sig ure of wner/ Lessee/Contractor as Agent for Owner
igniture df Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF TNdiN
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
by
this day of 20_q_ by
this-,1 day of,20 1J
(�
CJ' "� - 1��\W` � .l_JCI� �
i� /►ry5�a� �,t fask Dy'n
Name of person making statement.
Name 6f person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification I�
Type of Identification
Type of Identification
Produced (i� ice.
Produced Fl-Q1L
(Signature of N
[ _
(Sign re of Notary Public- State of Florida jM Lutz
Commission No
ELLEN VAUGHN
�`SPaV PVAi
State of Flur�da y Public
:. - (�
issio at
1
Commission No. ��s-qQ� cQ N TARYPUBLIC
OF FLORIDA
; 70079
�ro Of . MY Comrr•:;:.:ion krpires
cicto - )
_W,�TE
.; ? Comm#GG145994
"FUE IV
Pi res W/Z014UA_1
REVIEWS
FRONT
ZONING
SUPERVISO
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
01,
COMPLETED
ev. 2/7/19