HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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FEB 2 71018
Building Permit Application Permitting ®9Partment
Planning and Development Services 5k wglp County
Building and Code Regulation Division S
2300 Virginia Avenue, Fort Pierce FL 34982 Cq�A
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential K stSt 4 AS'),tic
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: //y/Z ✓ - IAI , T7,
L 3
Property Tax ID#: iV36 - ff C7! O6�- '7 OOC)^- CY
Site Plan Name: 6A-8t.✓ i//N,,/LLT 512 13 1 o,�- o2 LvT e
Project Name: I eA 4Ce 111 otir Fi T t °�I�
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
Electric Plumbing _Sprinklers _Generator
Total Sq. Ft of Constructio / biV N Sq. Ft. of First Floor:_
tCfCvrtstra�ctio��n 5y 6� Utilities: _Sewer Septic
Lot No.
Block No. Z
Windows/Doors
I Roof Pitch
/ y8 V
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name c/ 5b& 11-61
Name. . C MC41,v
Address: /7ff '/ /,30- AEU A),
Company: ftrlw.4 i�No%F%g5
City: Vim»,'%42 State: rl�
Zip Code: Fax:
Phone No. 01 - 373--7Z3S/
Address:.273/ 61L 34m DO,
City: 0G/+"AI - Stater
Zip Code: .35/t! 7L/ Fax: /✓��
Phone No
E-Mail: adodd A 7M,4,Y,. 64
Fill in fe mple Title Holder on next page (if different
from the Owner listed- above) - —
E-Mail nJl/i
' /1Z
State or County LicenseJ�f�
IT value or construction IS $ZWU 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.
1,
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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 JOB SKE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
1• /
Sig atu Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `
COUNTY
STATE OF FLORIDA
COUNTY OF
OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _2Dday of _(-e(i ,204by
this _ day of ,20_ by
r-ymi .natalA,
Name of person making ng statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificatio
Type of Identification
Produced fp`I _��
Produced
(Signature of Notary Public- State f Florida)
(Signature of Notary Public- State of Florida )
ELLEN{;�
Commission No. �'`�` �'=$rate
o. (Seal)
of Florida
o 2ly'Pa7p.
w Commission
'2 ,,
GG 270079
Oatobar
22, 2022
AGETATION
REVIEWS
FRONT
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SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED
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