HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 6-20-19All APPLICABLE INFO MUST BE COMPLETED FOR APPLIC ION TO BE ACCEPTED
Date: IOA6 Permit Number: lqo(- 0,543
SCANNED RECEIVED
BY
JUN 2 0 2019
qt6,01111-alloermit Application nt
Permitting Departme
Planning and Development Services st. Lucie county
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMI TYPE:
Address: 44-22 /J Aor 41A-
Property Tax ID #: 4- - -7-o 4' — DEC> Z/- — 00, 0 3 Lot No.
Site Plan Name: Block No.
Project Name: AQo�\,IL2t �-A
IZU5� I D E�OMJAL_ kAW 00AJ'5=0QT/C>^_)
F'
ATIMINAINO
,R 10TAMUil-e W
Additional work to be performed under this permit -check all th�t apply:
—Mechanical GasTank Gas Piping —Shutters V--W'indows/Doors
'-/Electric '--�Plumbing Sprinklers Generator -Roof Pitch
Total Sq. Ft of Construction: 7,q-,ov Sq. Ft. of First Floor:
I
Cost of Construction: $ Utilities: V-11s, I ewer — Septic Building Height:
M. Zi R, 1 @ 07% 0 9 6- -_5 0 1 1007NOTL7
RAWRIT-MR, AM.
Name VENETIAN AP IMI�E�T/QAJ LLC Name: A&,UAA.70,t2 gE)!E� 79)IODO
Address: 7*oo v) FLA6LU-a Company: A P-TAP- OVA) f,�0-771�-,VO 4C
City: At/ AM] State: 474- Address�-- 6W
Zip Code: Fax: - city: _�State:
Phone No. 77e(o - 1512 Zip Code.. 3N q,_Z5 Fax�'
E-Mail: YOYt tn home.5' c7ovki Phone N 0�'
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or C ountyLicense
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.
VSWRQ0.@W,,1=H1NfflM9 @ 19 1 1 N' FOR, I M Wffi UK N'
DESIGN ER/ENGINEER:
Name:
Not Applicable
4
MORTGAGE COMPANY: -**Not Applicable
Name:
Address:
EALM f�2j;b7Tr.9,910
Address:
City: State:
Zip: Phone:
City: ejeAQO State: i�;t_
Z - 17;_
ip: 3 2 0 - Phone �05
FEE SIMPLE TITLE HOLDER: L/Not Applicable
Name:
BON DING COMPANY: vl�ot Applicable
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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 IF 41LURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROYEMENTS 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/ Lesseq/Contractor as Agent for Owner
7-
Signature of Contractor/Lice�e Holder
STATE OF FLORIDA
COUNTY OF 9V
STATE OF FLORIDA
COUNTY OF
Cz
The forgoing instruynt was acknowledgedAefore me
The forgoing instrument w s acknowledged before me
thisA 6 day of 0 AJ 20—Ll by
this r16 day of 20_ by
_j;7
Q402110112 A_16b)l
me of person making statement. r
Name of person rrWing statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
C_
Type of Identification
Produced R (
Produced
?w
-
(�:_ L0_46_1�_
(Signature of N
VAUGHN
(Signature of Notankl' . 3��_
T P&, I
;9" ELLEN
1 VA
ELLEN
Commission No state of Flori 'W ary Publi
M 270079
S t a t e 0 f
- r _ 0 _4�NUGIIN
�,?( Otary pi,kn
Commission No. Chen— - 0
Sol in # (3G
iW9
C mm ss on
M) c6mmis ai2n Expires
my 0 i Sion 270079
Irnrn S -Expires
thl, !
REVIEWS
'7dWfff(f
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
M"MR-M-44E
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
PLANNING 'I& DEVELOPMENT SERVICES
BUILDING & ZONING DIVISION
2300 VIRGIN, IA AVE
FORT PIERCE, FL 34982
(772) 462-155� FAX 462-1578
CHANGE OF CONTR,4
PLEASE SELECT ONE OF THE FOLLOWING:
V CHANGE OF CONTRACTOR — Change o
and the new contractor of record for the current permi
contractor information and signature. A new Notice (
for job values greater than $2,500 ($7,500 if A/C
commencing any work. There is a $50.00 fee for the
CHANGE OF SUBCONTRACTOR — Subci
The new subcontractor must fill out a Subcontractor �
Contractor.
Contractor is to be signed and notarized by the property owner,
A new permit application must also be completed with new
'Commencement must be filed in the new contractor's name
Change -out). A recorded copy must be submitted prior to
l,'hanze of Contractor.
changes are to be completed by the general contractor.
t Form. There is a $50.00 fee for the Change of Sub -
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
Cancellation of permit is to be signed and notarized b�, both the owner and qualifier of record. There is no fee for
cancellation of the permit.
Date: 626'ZO—
Site Address:
k 2 2 /\/ Jho�- A
Original GC, subcontractor or owner/builder
New GC,
Reason for Cancellation
The undersigned does hereby agree to indemnify and hold ham
costs, fees or damages arising from any and all claims of action
contractorAubcon.tractor or cancellation of permit. A permit ca
SIGNATUREOF OWNER (or owneribuilder)
PRINT NAME_ 60
Permit Number:. JJO/ —0,54--33
LicenseC4C0qiV1 SLC License 30'7-TO
LicenseCrIe SLC License ��NI+3
St Lucie County, its officers, agents and employees from all
any reason, which may arise as a result of this change of
t be cancelled if work has Kep performed.
ATURE GENERAL CO �ACTOR (or new GC, as applicable)
4TNAMEA- 7oo Aere�� "avo
I
State of Florida, County of St. Lucie County State of Florida, County of St. Lucie County
'nie following instru ent was acknowledged before me this The following instrumWas acknowledgeKl before Me this
iWay of—,T12 121q by�-ft�' �0 j!gY7'
day of Selfln—e 20 b-,,"7%ef0--
1W who i ersonally, known to me — — — — — — who is personally known to
or who has produced- as D). M, e or who has produced PCIPL- as 11).
qw a uv)*�k
,`!gi �.at.reoffotary D.i� Si I gnature of Notary V Date
Revised 04/15/16
HERINE C. PEDROZA ELL.EN VAU
KAT : GHN
State or a P
r blic
N, of Florida-Noter�y NP
270 q
sio u J
My COMMISSION# FF977632 ublic
Y
Commission # GG 079
EXPIRES: Ju� 31, 2020 4� 2:7
nff,
Bonded Thru OF n C 11 , I st 0 XPI S
Notary PubUc Undw**= b&t19nffi'1rs1on E
r 2 . 0 Wes
lx� 20