HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date: f--� l - L 9
_4rED FOR APPLICATION TO BE ACCEPTED
Permit Number: I I o l ®l(�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
Building Permit ApplicationJAN 31 zols
Permitting ®'Aartment
St. LucieCounty
Commercial Residential X
PERMIT TYPE: Q,Dn t�lotJ/(� NOvA�l�t�l
PROPOSED INPROVEMENT LOCATION:
Address: l 0'7o1 •Sou-�L, Uce-%' b�-i�P lo'f log
PropertyTaxlD#: '4511 G10'01ob•cC)I>•4 Lot No. wog
Site Plan Name: X/': U+VM .(>J+A- - Tubt►4ra fit`'« Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
tZeuieve 1= -otJt vVikt_t_ or st Ve PbMR- rWCQ.Ss 4K3A 1z".6 lx%-'f f0-nnJ+
' - _
NSTRUCTION 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:
Cost of Construction: $ 2,250 • ��
Sq. Ft. of First Floor:
Utilities: Z Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ljl%> XX TAPol-5161 j-ALLefhwpM
Name:
Address:lo'Tol Se.Oceig+i IN-Ase
L-0+ Sub
Company:
City::3P1 -wen.) (JE 0
State: I
Address:
Zip•Code: 14a15% Fax:
City: State:
Phone No. 4 90
�L
Zip Code: Fax:
E-Mai1:Aa, /I%°csi Q'i. al'-1&e,.17g?--f
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) '
State or County License
efp^
if value of cahhstruction 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.
SUPPLEMENTAL CONSTRUA'N LIEN 'LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: caeveun--d bes��.afv,T Gerle�/
—
Name:
Address: loo ,av-c A\ S%s' %-Ve 2*
Address: 1
City: $;C--+ Aer-up State: r-I
City: State:
Zip:34C:t5a Phone zolo
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine work or recording vour Notice of Commencement.
;Q9,4w.-. A A A
rAt
ilgnure of O r Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF I �,e GQ
COUNTY OF
The forgoing instrument was acknowledged before me
131 cW !�
The forgoing instrument was acknowledged before me
day 20_ by
this day of G..0 by
k I n Lu L� ( l✓
this of ,
Name of person makirig statement. IName
of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced[ n l
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
``,,,, 11 I�jIELL �1
Commission No. •c` - to of F1 `No ery Public
Commission No. (Seal)
Commisslon 0 GO 270079
IIII 1
October 22,
2H22 _
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