HomeMy WebLinkAboutBuilding Permit Application Corrected 7-9-20— l)1 W
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578
PERMIT TYPE: h-
,s
P rmit Number,
a-
C�l pF0
Building Perri pplication
Commercial Residential
Address: l n:g- a Q, �
Property Tax ID #: V5 i 2- 5 00 0 1 -- 9 ® Lot No..
Site Plan Name: i, `i} Block No.
Project Name: C f � !' 1�� P
Additional work to be,performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: �q
Cost of Construction: $
Name
Addrp«
City: 4, A _ State
Zip Code: Fax:
Phone No.
E-Mail:
_ Shutters
_ Generator
Sq. Ft. of first Floor:
Windows/Doors
— Roof Pitch
Utilities: —Sewer _Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owrier listed above) -
Name:_✓��
Company: LCQ.� -z4''C R
Address: WS- ,
City: TA ��-�./`��2 State:---P0
Zip Code: 75" ��Q Fax: 70g q
Phone No
E-Mail 17�5 `�Ir� �+NVNc7i • GWI
State Count License 2
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.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: )- -? 'Peo-�(? Permit Numl
Building Permit Appli
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
JAN 8 2020
Pelrri'iittiilg Depcarl" ,ent
Sot. LLICIe Lour FL
Residential.
Property Tax ID #: / a 0 — (f) Lot No.O
Site Plan Name: 3 J P "J e Block No.
Project Name:
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: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
NamAI-
City: P1r C e ve r er
Addri it State: G
Zip Code: 9 0 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: c�Q �V e-ro _
Company: Cow 1 rvC(, ►-) UGC
Address su1 L' I b0/ C 1
City: State: C-
Zip Code: b" Fax:
Phone No Z? 1 00
E-Mail eler WV<,0 (�- 6 ri
State or County License (, V- C_ 133 d) 0 3
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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE, COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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."
'l
Sign.p,fure of Owner/ Lessee/Contractor as Ageni for Owner
Signa re of Contractor/License Holder
STATE OF FLORIDA4 -
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instru nt was acknowledged bef re me
�
The fo oing ins ent was acknowledged before me
�
this day of 20 o20byl
this day o 2Q�ZO by
Name of person making statement.
Name ofpepWn making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden fic io
Type of Ide ti i t' n
Produced
�)VUad (Z ,
Produced
/�2_
PW
(Signature of Nota P lic- U
(Signature of Nota ublic- State of Florida )
SPAY PU' AWREY B. HUMPHREY
Commission No. °=Aw COMMIS(590GG300817
Commission No. Gd'r.,
j'HREYEXPIRES:
March6, 2023MYSION
FUDREY0
# GG 300817
~ a
= 6 2023 3
JjaR;.•3 41
Ci.JM9.••..
.'9TF F c ;;'Q
Bonded Thru Notary Pul
41c Underwriters C
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETITI_' -
EVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19