HomeMy WebLinkAboutBuilding Permit Application' `�•' 02/03/2012 08:11 FAX 0001
,,All AP.PU(;ABIE.INFO MUST BE CQMPIMD FOR.APPLICAtION 7O BE ACCEPTED
Date 5� f r Permit Number:
building Permit Application
Planning and Development Services
Building and Code Regulation Olvlslon
2300 Virginia Avenue, Fort Pierce FE 34982
e ercial Residential ..: ;
Phone: (%%z) 462-1553 Fax: (772) 462-257&t
PERMIT TYPE:MW
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Address , . DSO i . lxlatM L71� t N it ' .� .
Properryt x ID # 010 o I t No
Site Plan Name.., �r,�Nct'a,Q�;,.—uNkT
) i3 v�k.tio
Project"Namej"NCS
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nr'✓t� n �.t'p�_%!l!oF►f:N�,.�... ++u ► $�etn.i iw�S. 1 n1'�.1�'sr� doaY' �_
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Additional work tube performed, underthis,permit—check all that apply:
Mechanical Gas Tank .. Gas PipingWindows/rigors
:Y F
Elecrnc Plumbing Spnnklers Generator.... - _Roof - Pitch'
-
a
Tvtal.5q !`t of Constructipn: .�Q m - -- Sq_-Ft. of First Floor.,
Cost,of,Construction; $ A&.j6n6 Utilities:- Sewer _Septic Building Height: •/-.5*- -
Name: �i��t s'R.�lrtS n1
�i _ �0ompar
A dress .. ,�F�" � 9�oti5 5 � Oc" it . y ��• . _. � .. .
Address:
Zip,
.Code:.3.� �i,�Z� �,�s? 5`� fax.
M EiLY ;• tC State
Phone. Na....J?• 1.n 4,.0 D - Zip Code. +3!9i $- .. ,,-Fax:,.
z
it Mail 6els ra a 1%1 Phone No 7
c t
FiII in fee Simple Title Holder on`next page (If different E-Md HIV ri�i' �5 �Aia0 �"Ga►�A.
from the Owner.listed:.abave):,. ; :: =.•State or=CountyvUcense 0350 31
If value of construction is $2500 or more; a RECORDED Notice of Commencement is required.
If value of HVAC s $7.500 or more, a RECORDED Notice of Commencement is required
t
SUPPLEMENTALCONSTRUCTION
LIEN,LAW,�INFORjVtATION
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: Al
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name: Al
f-�-
Address:
Address: r
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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencing work or recording vour Notice of Commencement.
i
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature ontractor/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
S%Kzn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
V Physical Presence or Online Notarization
this _ day of 2020 by
this M day of 202$ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
s
(Signature of Notary Public- State of Florida)
(Signature of Notary Publiio State of Florida )
Commission No. (Seal)
Commission No. �pI{MIN13
W I$$►ON li 13G 275060
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGET I(dP!.`r�
COUNTER
REVIEW
REVIEW
REVIEW
REVIE
EVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 5/6/20
'--, +02/03/2012 08:12 FAX
a 003
DESIGNER/ENGINEER: Not Applicable
Name: iN/--- -�-
Address:
City: _ State:
Zip: Phone
FEE SiMPLE TITLE HOLDER: Not
. �p licabl
Name:, Or&-04W01 ��.L
Address: � t? 5 -Or-agw Q�,'A /002—
City•�
Zip: Phone: 7�7
MORTGAGE COMPANY: _ Not Applicable
Name:""._ -
Address
City: ,State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name -
Address:
City:
Zip: _ Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do thewotkand 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 confiictwith arry 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: roorn 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 PAYINC
TWICE FOR IMiPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT W(ST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YobR LENDER OR AN ATfORNFY BEFORE RECORMNG YOUR NOTICE OF MMEN EMENT." _
Signature of
r as Agent for Owner I Signature or
STATE OF FtGROA-
COUNTY Oi=��qu
Tne o prn insi Vu ent was acknowled before me
8 6
tn►s-day(of,,.fNkm � Z0 by
AWA5
Name of person making statement.
Personally Known OR Produced identification
Type of identification
Produced ia_, L'jg��AAR
(Signature of Notary Public: -State of IR&ida)
Commission ,No. V ABRAL
�VICTT R
nrnTARy PUBLIC
Cobb
REVIEWS 'FRO T Zomfitsof
COLJN E A�i]=wpii
DATE
DATE
COMPLETED
ev, Z77119
Holder
STATE OF
COUNTY OF._.. Q _
The forgoing rnstm ent was aartowledg ((before rve
this I&day of Z0�1 by
1 0,44.5
Name of person making statement.
Personally Known OR Produced !dentification Y'
Type of lde ificati 1 i
Produced 1 'Q L�ee���
of Notary Public- State of
Commission iVo. 'r ViNOT '�UBL
_ Cobb County
..,_. �jj
PLANS I VEGETATION f
ZEVIEW I REVIEW