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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 6-20-19All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: (, (;Nn Permit Number: / / %�% O Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT TYPE: Address: i le) v ffiv' 0 SCANNED RECEIVE[ BY St Lucie County jUN 2 0 1019 Building Permit Applicationr'Ittin9oepa"I "t St. Lucre County Commercial Residential PropertyTax lD #: 70 0002 00017 Lot No. / Site Plan Name: Block No. _A Project Name:t3�j'�/1,�- 12C'�5i i A--_) &L 10C� C,00,S70V 6V 0 A--) CONSTRUCTLC?N INFORMATIdN: 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 /Z Pitch Total Sq. Ft of Construction: I -1 T Sq. Ft. of First Floor: Cost of Construction: $ �o9y O®'O- ov Utilities: '✓ Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name %/1fW97'7-4n1 A9AV415TUi Lc)A) LA C- Name: AOMAACDO Address: ;TIf 00 it) FLU Loz 9A' Company: A914Q 0V6Tac��rpN LL.0 City: M""k Stater_ Zip Code: J319-+ Fax: Phone No. 6 '- ZY M -- 4 �' Address: 13360 SW Z40 S7: City: , MIAMI State: FL - Zip Code: 33145 Fax: Phone No ��i 3 Li 3 6Ss E-Mail: 'VO �ytovlJ✓►Ovnng, C�ov>7 Fill in fee simple ritle Holder on next page ( if different from the Owner listed above) E-Mail I�P2S�ol1 c��o�€ �c�h�D- emh-, State or County License Ca r52-7 -445 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. SUPP EMENTA! C©NSTRUTNNAW1NOACO MTIN DESIGNER/ENGINEER: _ Not Applicable Name: r—A/I,*)+T # L-0;;Sy ci .4 MORTGAGE COMPANY: Not Applicable Name: Address: 'O 920A-L IorAyfg *ew Address: City: yGIW &FAC4 Zip: 32 R% Q Phone 472 State: F-C- — `7 —55D5 City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Name: Not Applicable BONDING COMPANY: _Not 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 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 Owne / Lessee/Contractor as Agent for Owner Signature of Contractor/Lic nse Holder STATE OF FLORIDA � SitW� STATE OF COUNTY OF COUNTY OF -_ The forgoing instrument was acknowledged, before me The The forgoing instrument was acknowledged efore me this .N _-,)day of SrJA)� 20 by this flay of So A) 20�by nM(�Un )IC _Qigl&fib Name of person making statement. ' v Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced F� / _ D 1- Produced 95 _ D Ek1n1l (Signature of Notary Public- Stat&Af Florida) (Signature of Notary Public- Stat f Florida ) Commission No. LLEE .GHN "yls'., Public Com i S; !wno FI I Fni vAUGHN °��=State 0 4 State of Florida -Notary ;_° of Florida-Notar Public G 270079 = *= Commis , y Commission Expires -" � , o,,`` y Commission ����� Expires REVIEWS F (`d 2Y, OR PLA ob r 2P URTLE11 MANGROVE REVIEW REVIEW Kn I ETV REVIEW DATE RECEIVED DATE COMPLETED Rev. 2/7/ 19