HomeMy WebLinkAboutBuilding permit application I '
All ANPLICABLE 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: 5 �e FaVA- KtS_%
PROPOSED IMPROVEMENT LOCATION:
Address S idsk P At Tra. 1
Property TaxID#: ��D� - Na OOaS- �170' y Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION IF WORK:
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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: o i 6 Sq. Ft. of First Floor:
Cost of Construction:$ �.DW L5f Utilities: —Sewer )6 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 'S+eV_vN DLXV n Name: 7411, A. G,-cs
Address: �)UU L0.aL % dZ 1,-&YxP- Company: &M2.0
City: AAcU oo State:VT Address: 511 SW .Par-1- S�•�,�,�c ie BI�d
Zip Code: ()5LlJI Fax: City:ft-t-E S4• L► c l e. State: �L
Phone No. Zip Code: 3-1953 Fax:
E-Mail: 5 '&dev'r alt^V\ (�QOI ,C"orN• Phone No -1172 - 315U - 1653
Fill in fee simple Title Holder on next page (if different E-Mail 702td a----) 15 ryp�u+4crS• C'oFvj
from the Owner listed above) State or County License G(rL /52 L)73q
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW I.NFORMATIO.N
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Chr15 &crS Name:
Address: I1040 Nwiloo r Vx&Ax, f- Address:
City: Q„Mks G-ord-- State: V L City: State:
Zip: 33q Y3 Phone q41-"Ic. - OkP35 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 NOT1W OF COMMENCEMENT."
Signatu of Owner/Less ee/Cam actor a Agent for Owner Signatur f Contractor/License Holdir
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SA WC (e— COUNTY OF CJ WC 1 C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 106 day of NWerAloe r 2019 by this�V6 `d-ay of NNenib f- /2�•0 /�+� y Q�
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 driyeA 5 license— Produced ciriye,i s i i c cos
(Signature of Notar ublic-State of Flo ' — gna ure of Notary Pub' State of Flor'
BRIANNA GRA Af BRIANNA GRA A
Commission No. 6(-,DS9 1 Os �Se f`�s MY COMMISSION 8910m ssion No.6C�d� ! OS S 7 MY COMMISSION# G 9105
' = EXPIRES:APR 0 ,%2� �, EXPIRES:APR 0 , 1
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"401� �Bonded through 1st Sta a Insurance Bonded through 1st St e I urance
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 19
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