HomeMy WebLinkAboutBuilding Permit ApplicationAII.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 3k ItR' t!SO (0
J'Yl,ogs�e r sa;la�
RECEIVED
Building Permit Application
Planning and Development Services S E P 2 2 2 D 21
Building and Code Regulation Division St. Lucie County MUM "U""'`
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1�
PERMIT TYPE: '�� m Q �grYYl
PROPOSED IMPROVEMENT LOCATION:
Address: LI S
Property Tax ID #: 114 % 7 .21-s 6 0010 / 00 a 4 Lot No.
Site Plan Name: Block No.
Project Name:'
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: u Sq. Ft. of First Floor:_
Cost of Construction: $ a�� / S10 . oc�)
_ Windows/Doors
_ Roof Pitch
Utilities: _ Sewer _ Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name lkxul Oman r.
ame: � �� � Gl.t e-, ` C.
Address: /-QO,)C
ompany:
City: Y?,)*z Q t-CLC %1 State: L
Address: to lO 1,SbG
Zip Code• `�% T Fax:
City: ��3 eaf AQ State: FL
Phone No.
Zip Code: 3o-i 94,2. Fax?7.2-79y-34oY
E-Mail:
Phone No 771-7 9 cl^ QQ-ao
Fill in fee simple Title Holder on next page ( if different
E-Mail &C 0 A/ 4A-e . C OM
from the Owner listed above)
State or County License- %.-F —O(z %) I 1 E 7
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.
r SUPPLEMENTAL CONSTRUCTI N LIEN LAW INFORMATION
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: 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
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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLOSIPA
COUNTY OF d e 4e 1 r
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COUNTY OF �iQ A-y�.�—
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The forgoing instrument as ac nowledged before
this day � 20-34 by
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The f�orPomg instrucme_nt/was acknowledged before me
thisolbl day �BL�F�m�0 byft
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of, .20&,
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Name of person making statement.
Name of person making statement.
c
Personally Known ✓ OR Produced Identifica
n
Personally Known OR Produced Identification
Type of Identification
'
Type of Identification
Produced
g,';o
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 1/ // 19