HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \0(, Permit Number:
RECEIVED
Building Permit Application FEB 2 0 2019
Planning and Development services ST. Lucie County, Permitting
Building and Code Regulation Division
2300-0—rginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
BY
PROPOSED INPR VEMENT LOCATION: 6t. Lucie County
Address: 1114 PSI om st- 34qs2.
Property Tax ID#: 340LE 521 QlaS 000 $ Lot No.
Site Plan Name: 5c)b-4,ard Block No.
Project Name: J0
DETAILED DESCRIPTION OF WORK:
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 _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 35,S20. 00
Sq. Ft. of First Floor:_
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: '.
CONTRACTOR:
Name
I0—N01 R'$ D w 0.
Name: e 9-
Address: 1114 e tQA V AJ
St
Company: (ZI Zor1 DD) S 1 /1 G
rr
City: 17-+ Q 1 C I' IrI e 6, State: r
Zip Code: 3Y SZ Fax:
Phone N6r7. Z q 20
Address: -542-3 �� CA445
City: IGrp C- State:
Zip Code: 3"91 Fax:
Phone No % A 9'n/-8510
E-Mail: mA: IMU/wA 4zol aokcOn1
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail �Dr ILU MAIL:
State or County License C b
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:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
commencing work or record i our Notice of Commencement.
//i plee5
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA / r
COUNTY OF ��I,
STATE OF FLORIDA /�J�I , , �&
COUNTY OF /dr �a�r
The forgoing instrume was acknowledged before me
The forgoing instrum was acknowledged before me
this day of �201_1 by
this j5day of � 20_0 by
A z`►olas S>91.c-1 a-1 0
Lk. % 2 rr) U4>Z1C.iu
Name of person making s atement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ll�OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
aLj�,e,,
(Signat of Nota lic- a
(S ature of Notary Public- State of FI ' a )
MOTARYPU IC
Commission No. OF FL &
: r .: ^1¢amft .
Commission No. !Rr"`=: Y
OorivrWC4632559
a`Irs:::�Q STATEOFfLORIDA
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATI
960IFNIM/9
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.9/26/113