HomeMy WebLinkAboutappAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -71 d Icl Permit Num
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
PERMITTYPE:
PRUPCiSED'1MR ,'QAM NT LQ'CATI{�CV >`
'Il �
AILA4_13
JUL 15 2019
i0Ihitting Department
St. Lucie County, FL
Residential �--
Address: I H 1 _7 L6.,ic, PAc Os' • .
Property Tax ID#: 3'-IG�-SDI-pU1� 000-o Lot No. )
Site Plan Name: Block No.
Project Name:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ ($ `i� Utilities: —Sewer —Septic
11
_ Windows/Doors
Roof Pitch
Building Height:
OU1tNRf LESSEE x
TOR
_ CCiNRACT%
Name \A/c•rrrr\ M: kkcrd
Name: e_
Jan
Address: 2WS' /v1zk\1c.rJ Lt
Company:
Address: ( ucr Wc\, dt O r -
City: Fk P icr e. State: r"l-
Zip Code: 39 A8 3 Fax:
Phone No, 772, - z I & " 298V
City: I�fi P ► eJ -Cc- State: ► 1-
Zip Code: 3 Llot''IG Fax:
Phone No 72 Z- 3 Zl - 7S1 6
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail,"SrEencG-�q�
State or County License _
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.
SUPPLEMENTAL CONSTRUCTION i_IEiV LAW INQRMATION
:., �, -f.F 1 a,
— w. ..... ,_ _,�.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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,
Iaccessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
`iYVARNING 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."
!
I
Sign re of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA II
V e
STATE OF FLORIDA
Told a ✓1 I��Ve
COUNTY OF
COUNTY OF
The forgoing instru ent was acknowledged before me
this__L day of 20A by
The forgoing instrument was acknowledged before me
this —Lday of It4lie 204 by
Name of person making statement.
Name of person making statement.
%�OR
Personally Known Produced Identification
Personally Known L/1" OR Produced Identification
Type of Identification
Type of Identification
Produced _
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. 0v :No taryPubl(Sti'66ofFlonda
Commission No.
o ChfiBtoph@[ P Flood
Notary Public State of Flonda
My Commisa�on GG 3196®8
�pM�
, Chgstopher P Ftood
REVIEWS
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
iRev. 2/7/19