HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr ..
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: a Cp Permit Number,
Building Permit Application FEB 2 6 2019
Planning and Development Services one a ruuntY, Permitting
Building and Code Regulation Division /- _
2300 Virginia Avenue, Fort Pierce FL 34982 iJ
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential SCAN ED
PERMITTYPE: �a St. Luci ounty
11600S ' INPFtOVEMENTLOCATION: "
Address. 77G/ yl�12�o1z L�R)1J rIf_l�SoI11J�IL FL3�fg36
Property Tax ID #: �1-J� ( s- - / Lot No. 76
Site Plan Name: �%%):� rjzLz� /OAA5L TT Block No.
Project Name:
LkknnC L EAr n OUl 3- .T- � 44bcic J0drLn`1 GUIT74
,f3 lr3i WISTI-KG Wiza GUi47222C Cd�IYJ�S�Y�>
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: WA Sq. Ft. of First Floor: 4112i
Cost of Construction: $ %�iM, OCR Utilities: _Sewer _Septic Building Height:
OWNERj[ ESSEE " " -
CONTRACTOR;_
Name CJ79y S JQJqT2':2—
Name: WL/MAI C W57&VgUa,1 CF XtL
Address:%961 SfiM)E� ICS+Z07- ,Oi2
Company:
City: IID - 57A/A% I JCCJk= State:
ttr�y�,� m
Address:�� mix O'Ce
City: P6rZrt-4-,7-(J -1,L Stater?
Zip Code:31Rg4 Fax:
%7a' q%'7 -tea
Zip Code: 2y2gk Fax:
Phone No.
_Phone No 77a-aQ -2 og
-I (a AtQQ C_rY[1 —
Fill in fee simple Title Holder on next page ( if different
E-Mail r) [)CiYJ /IO2-)-drla @t' J2h
from the owner listed above)
State or County License QPG
If value of construction is $2500 Or more, a RELUKutu Nonce or Lommencemenc rs requl, + ,
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
Z. LJRRLEIVVIE
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CO�NSTRl7CT10Nu11�IV LA IG it1E
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MATRON
DESIGNER/ENGINEER: _ _ _Not Applicable
Name: MfCJAL-_L Y' 1716RA7\1
MORTGAGE COMPANY: _Not Applicable
Name:4(inr—
Address 7g�i S
P, '�}< i7
Address:
City: F�' )tip,, State: >%L
Zip: �-NJ1ZC Phone -Z2.
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 AFFFDVIT: 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 l 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 ghd posted on the jobsite
before the first inspection. If you intend to obtain financing, ^nQconsult with lender r an attorney before
-L)FFJJJJt!nLJ11P w/u/r 11ULUIUIn rUl IVOLI.. ", ��•. •...�..--...-..-.
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Sigt'ure of Owner/ Lessee/Contractor as Agentfor TOwner
Signatur of ontractor/ tense Holder
STATE OF FLORID! 1
1`
STATE OF FLORIDA
COUNTY OF c ,1�
COUNTY OF
Thefor oing instrump s acknowledge before me
The forgoing instrument was acknowledged before me
by
thism.dayof t'��. 20,.j
this_ddayof .20_
onn_
v_ n
i� if1
l('ilny�/�P Y I� loan
Name of person making statement.
c _
Name of person making statement.
Personally Known OR Produced Ide 'fati
m �H
Personally Known OR Produced Identification
Type of ldent ication
v c
Type of Identification
Produced �
a E i
E m
Produced
Z.aom
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(Signature of Notary Public -State of Florida)
a
(Signatur of Notary Public- Staof Florida I
T
Commission No.86 i84?pJ (Se
i. i
Commission No. (Sear .
REVIEWS
FROM
ZONING
SUPERVISOR
—PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 9/Gb/16