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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� q Date: SCANNED Permit Number: ICIN 'Q©� BY St. Lucie County RECEIVED Building Permit Application APR o 3 2019 Planning and Development Services Permitting Department Building and Code Regulation Division St. Lucie County 2300 Virginia Avenue, Fort Pierce FL 34982 / Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMITTYPE: Re ROOF I r: Address: Property Tax ID#: 3NO2- UOU- 0092 - 000-Y Lot No. 7Z Site Plan Name: Block No. ;IV Project Name: LoRi GroyC 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 jZ Pitch Total Sq. Ft of Construction: yak Sq. Ft. of First Floor: Cost of Construction: $ ��I % %�P Utilities: _Sewer _Septic Building Height: /Q r OWNER/LESSEE: CONTRACTOR: Name Lop- r t ,� Name: G✓�11;AM e6&"l%S Address: S30& ofnryl"Ho DR. Company: J31/M 7err✓I I?Gft,l rgaU for+ city: Pf plp 2a i? State: FL Zip Code: 3Y9fZ Fax: Phone No. 777.-S77-toIrto Address: I/05D S' 6(.f /-/WV ; City: _TuPrK2 Stater Zip Code: 33Y7i Fax: Phone No 7yO-779'-2bo L/ E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail 7errni?'I P J*r-m-M Lm u.rA. COL State or County License CCO122IY6/ W a6&3 7 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: Name: Not Applicable MORTGAGE COMPANY: et Not Applicable Name: Address: Address: City: Zip: Phone State: City: State: Zip: Phone: FEE SIMPLE TITLEHOLDER: Name: Not Applicable 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. Inconsideration 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA COUNTY OF alm Be3e-k, STATE OF FLORID COUNTY OF lm 13e8ci14. The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this IIday of ftrc4. 20_!,q by this if dayof A&reL .2019 by G'h�r/es „yiey_ln P.rrAhwsh ehar,&5 Odin Ir2lx 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 /� /I(�v Produced (Signature (Si JR Notary Public State of FWritla Commission o. Charles Kevin PiAgld61 scion G 9 3 CoF*"� Notary Public State of Florida Chades Kevin Pittman ( al) y ommus on GG 303933 Mw Expirea 02779/2023 � Expires 02l19/2023 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED 44.11 Kev. 2///1`J