HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE i eU FOR APPLICATION TO BE ACCEPTED
Date: Q _; -_ a Permit Number: [ Cl 0 051
RFC4VE@
r . FEB 2 8 20)8
Building Permit Application
err��h.�na lanning and Development Services uilding and Code Regulation Division sr LiOne couniyent
B
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential is
PERMIT TYPE:
Address:
St. Lucie
Property Tax ID #: 3 ` a6^ 9 (3:,-" 09�ig —Q 00 15 Lot No. J
Site Plan Name:
Project Name:
DETAILEO� DESCRIP7
ell /f�njo
fi 0� 4Y17 L
W 6 .
Ed:ti i+`... g #:x �.. • .d. 4'�O .•`. �. d:l?.. 'fa & �v .)
CONSTRUCTIONINFORMA ON:
Additional work to be performed under this permit —check all that apply:
—Mechanical _Gas Tank —Gas Piping —Shutters W' ows/Do rs
-
—Electric _ —Plumbing —Sprinklers —Generator of 91 (-Pi ?
Total'Sq.J:fof'Cons"fruction: or: !o
Ioosfof+Construction: $ A4& Utilities: Sewer Septic Building Height:-
9 NER/tESSEJE,-'
CONTRACTOR: ~,' t . .
Name « 5
ame:
Address:_L�Jko CA z rn UJIAM yX'C2�
Company:
f2 Y SY, u 'City: �OC' 7 State:P�1.
Zip Code:.' �9S 2 Fax:
Phone No. ,� /6!- % Gl `7 J�
;E-Mail:. _CZi; M 4!:;Fg C1"O Al 016? a, 4A 1/. C
Address:
City: State:_
Zip Code: Fax:
VBone No
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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.
SUPPLE MENTALCONSTRU CTI()N LIEN LAW INFURMATIO
C
= ;; :
DESIGN ER/ENGIjNEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
✓ Not Applicable
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. X 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."
t
Signature of Owner/ Les"a/Contractor as Agenffdr Owner
Signature of Contractor/License Holder
STATE OF FLORID � ���
STATE OF COUNTY
COUNTY OF
OFORIDA
:7he forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
this _ day of 20_ by
U K5 QIf
Name of person making statement.
Name of person making statement.
;Personally Known OR Produced Identification
Personally Known 'OR,Produced Identification
;Type of Identification
Type of Identification
"Produced
Produced
i
t-i(Signature of Notary Public- State cr State of Florida -Not
(1at
r �DIIC
a of Notary Public- State of Florida )
y •= Commission # GG
270079
Commission No. '�',�ai �,al) My Commission
)rpirggni
ion No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19