HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP�T •`D FOR APPLICATION TO BE ACCEPTED
Date: Lp Permit Number: 1��/ ,V 5
SCANNE® RECEIVED
BY
•
` St. Lucie County APR 161019
Perrnitting Department
Building Permit Application St. Lucte Countyent
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: E1,0-C-Ti—T CJ4i-
PROPOSED IMPROVEMENT LOCATION:
Address: ,4013N MID DIxtE H W V FoQ:rPlEkrE; FL ORz/gy,6
Property Tax ID #: aq0 3 - 60.2 — 00/ 8—p00 "O Lot No. lS
Site Plan Name: VV f7 / / l: Block No.
Project Name: ; 6-G A— wK I %I✓
DETAILED DESCRIPTION OF WORK:
A-T'O Tlz Sf—' 6-2?— TGh/ +AID 91,7'(= L / &-H72fV .
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping
Electric _Plumbing _Sprinklers
i
Total Sq. Ft of Construction:
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Cost of Construction:$ /3 00o Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 7 W,k- :t/N iTE
Name: 7774aW
Address: rgo/3 /V fy- D/X/E f1WV
Company:.—TVF1S
City: F02.T- PiE/ZGE State:_
Zip Code: a N 94b Fax:
Phone No. 7 7c � o?(n7 /
Address: -�' AL-6�Q/'>fH
A7^<
City: IA,1?8� f State:'
Zip Code: 37 / O—
Phone No — 3/3 — 2-
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail /yr5 t!F!� (eeyv1 L
State or County License 2-7 83
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 CONSTRU 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/see/Contractor as Agent for Owner
VY
Signature of Contractor/License H6Ider
STATE OF FLORIDA II
COUNTY OF sT L
STATE OF FLO IDA
COUNTY OF 4 M1L eq ch
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The forging instr ment was acknowledged before me
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The forgQQm,g instrument was acknowledged before me
I 'Bayof
this dayofII �20� by
this Fier_-1 201�1 by
K' J v W W. +?-
m r-\-3-t-h e w -3-. �-ye S
Name of perton making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
ProducedFIy,)Am 1)riJPr L crse,
Type of Idenjification tn�
ProducedF`10IZ'OAr yrLw&rc bc_.en,5
ALEX DE SOUSA
oaa o NOTARYPUBLIC
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(Si@ ature � a of Notary Public- to -p572888 �
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(Signature of Notary ublic- St �fa '�ARy PUBLIC
C
ONCE 19�� I s 11/1/2021
Commission No. % �da(�
_ STAT OF FLORIDA
Commission No. Z28ib = ' &iFF972870
h� Expires 11/18/2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 21 i/ 19