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HomeMy WebLinkAboutapAll'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� /� Date: Permit Number: IO(Q -0 (� !11S— _. _. _... _. Building Permit Application W19 JA% Planning and Development Services o31 Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 11 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential C PERMIT TYPE:�O i PROPOSED IMPROVEMENTLOCATION.: Address: �� 3 \C' AC 6&49. ftr> Property Tax ID #: �� �O ( ®�Cl'j ©3 E'Z Lot No. I Site Plan Name: Block No. Proiect Name: ETAILEI DESCRIPTION OF WORK., ." CONSTRUCTION INFORMATION: Jitional work to be performed under this permit -check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Electric _ Plumbing _ Sprinklers _ Generator A Sq. Ft of Construction: _ � 19 zo Sq. Ft. of First Floor:CPO _ >t of Construction: $ 3 6-00 j<p Utilities.: _ Sewer _ Septic Windows/Doors Roof Pitch Building Height: OVI/NER/LESSEE: - "CONTRACTOR: Name !jn I.,vv fk_ Vkc '7; n a Name:_- iAddress: S`i3G �C A�L Me�r(_To A� Company: COA JTK L �N Cbri 1Tti , ,City: f'- `� o ��c� State: _ Address: 47j0 %kk'k r1L..c' o v -7- City:State: 1;ZipCode:3 y Z Fax: ,Phone No. Zip Code: 3 q9 91- Fax: E-Mail: Phone No 99 01- 9 R-' 'Fill in fee simple Title Holder on next page ( if different E-Mail �+�+�� 72- 8i l` "�T ,from the Owner listed above) State or County License S'�l' L.ke_;,� Z© IZ9' 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 LIEN LAW INFORMATION - DESIGN ER/ENGINEER: _ Not Applicable Name: N Address: NqOl w& L 4-'D 1l10 S"'Tb City: 0 -vC�-o N O State: Zip: 312' l 1 Phone b 1420 SIMPLE TITLE HOLDER: _ Not Applicable me: dress: p: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name:_ Address: City:_ 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. 5tl 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. Inconsideration 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 Owner/ Lessee/Contractor as Agent for Owner STATE OF FLORID 11 COUNTY OF I` ; Z- L Lc - forgoing instrument was acknowledge6before me day of , 20_ by ame of person making statement. rsonally Known OR Produced Identification pe of Identification educed (Signature of Notary Public- Stat f Florida ) Commission No. y�M.RpHMING LASHAN�IN GG275060 REVIEWS FRt to I NP� REVIEW RECEIVED DATE COMPLETED Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before me this day of 20_ by Name of person making statement. Personally Known OR Produced Identification Type of Identification Produced (Signature of Notary Public- S to of Florida ) AY COMMISSION # GG 275060 EXPIRES: PecemberV, PLANS tL V96r: MANGROVE REVIE '""`R'@TOT7=17�i� REVIEW REVIEW