HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1 t.
All APPLICABLE INFO MUST BE COI : ^ ' 'ED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 170 [, om
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Planning and Development Services Building Permit Application'es /CuceCOu ent
Building and Code Regulation Division
2300 Virginia Avenue,. Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
€GANN€D
PROPOSED. INPROVEMENT LOCATION: - RY
Address: I D7D 1 S OCE)kN De 410(K St, Lucie County
Property Tax ID #: Lis 11- 90s^ 00(n('e- 000—z Lot No.(O(e
Site Plan Name: Block No.
Project Name: SFCE� P-�CpyrQ P�"�VO�
DETAILED DESCRIPTION OF WORK:
I CONSTRUCTION:INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator T Roof �Z Pifch
Total Sq. Ft of Construction: /,070 -fp PT Sq. Ft. of First Floor: 10003� fi'
Cost of Construction: $f000, 00 Utilities: —Sewer _Septic Building Height: g
OWNER/LESSEE: '
CONTRACTOR: ".
Name COLLC" U CkF.f
Name:-DRylh CAOs
Address: (0701 r 1X6191YP4, 0(06r
Company: FL0211)ft P-001-'IN6 SgAvICEC L-e-C
City: J61VS61V QEI4LH State:FL
Zip Code: 31)1157 Fax:
Phone No. —
Address: E470 Se OHIMLy5 ST,
City: !-FOBS SOLJNU State: FL
Zip Code: 33`%SJT Fax: ]72-S'1S-C)CPq-;
Phone No (o I -y17-928
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
('
r,d1z. (0 r M. Sergi ceS&q�/ Conte
State or County License C6Ll3 2'Y?&7
If value of construction is $Z500 or more, a RECORDED Notice of Commencement Is requlrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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:
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmpnrina work or rprmrdine vour Notice of Commencement.
Signature of Owner/ ee/Contractor as Agent for Owner
Signature of Contractod ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF M/t-AT/N
COUNTY OF M A" Ft n
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisZgTlFday of ,?MdDARs) 20 19 by
this Zxt�ay of J aiU--ar201 r by
C01-L6&V s1<154S
VltLAl A- - C� n ns
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification I
Produced
Produced P:L 1 rulj`s IiGLhoc
(Signature of Notary Public -State
I ure otary Public -State o 9f a, OYCE R. KOLLER
Byrn NotaryPudoState ot
JoshuaDCappS
Commission No.f F210 ?S e�yilj My �mmce 1'rPzt
dda f3, +*. Nola Public -state of
.:. Notary
!'::.`t Commission n GO 182
efsom ssion No.(TG If t 7ti / �1 aI�Y Apr2
ppo Eiplrea O4H8/2019
Comm. Expires
through National Nota
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
S7REVtIEW
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.9/26/18