HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: �� \ �� Permit Number: »dti, da0 d l
SCANNED RECEIVED
E BY
Ila St. Lucie County APR 0 0 Zp)g
Building Permit Applica i94uCie County, Porn
Planning and Development Services -
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: aa/
PROPOSEDIMPROVEMENT LOCATIONS
Address: 26- Ine;&6J, c a2aY
PropertyTaxlD#: Wy _70/- OfL3•O40-y Lot No.
Site Plan Name: / Block No. f 4,1
Project Name: Ct c,. I SCF ohc
LED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: 1
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 Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �?. �9T Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name PakL 3a"&M--Name:
i1 2 '
ma S pale c
Address: 21-q t,LeeW Pl%D 4'4
Company: rijo=P
ohs f k�� L•,r
City: �pi2/ iL�LCC/ Stater
Zip Cade: 3Y9 Y2 Fax:
Phone No. 0 ".S -
Address: E� 140ir Z,ST234 7
City: (kw &CIC
Zip Code: _3ZgC.5-
Phone No 772 - 3
, State: re -
Fax:
Z/-6J it
E-Mail: P-9— e-e�S e10 W
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail /�Hr�-�
A a cA01 CoK
State or County License
CA2. ivs 2 g-YS(
it value of construction is SZ5UU or more, a RECURDED 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/ NGINEER: Not Applicable
Name: ' �.� ' k CC C
Address: N A//1- S ; 2.ZS
City: 00/0 ca4 State: ir[
Zip: 3z c. 3 Phone 72Z.— z2/-ay _
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
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.
E0
ermit holder to build the subject structure
covenants that may restrict or prohibit such
it 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
UR ENDER OltAN ATTORNEY BEFORE RECORDING YOUR NOTICE oF_romNiEfflaMff.7
Signa re of C ontrac icense Holder
Signature of wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA I
STATE OF FLORIDA c
COUNTY OF(�(�
COUNTY OF
The f oin in trument vras acknowled a efore me
The oin instrum t w s acknowled efore me
this day of 20/'by
�r Apc=
this day of 20 by
c p'cc--�
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known ✓stOR Produced Identification
Type of Identific to
Type of Identification
Produced l
A
Produced_�l
All ,`( /� . /fTC.f�/` Q�
tgi' tC�
(Signature of Notary Pt IicB o
Signature of Nota
AH-State of
1 Notary Publ •State of Florida
'01y"o", TAM HENDERSON
1,p,;
Commission Na. Coen NGG 224334
Commission No. .. Notary Public(S�i)ot Florida
"'•.or!;.' My Comm. Expires Sep 27, 2022\;'
Commission a GG 224334
Bonded throw
\or r.,.My Comm. Expires Sep 27 2022
o
e through National
otary Assn.
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DATE
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DATE
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Hev. 2/7/3.9