HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \Naalkg\ Permit Number: ` d ^OS
SCANNED BYSt. Lucie County :RECEIVED
PR 2 2 ?T9
Building Permit ApplicationPlanning and Development Services ST. e County, �,_ Aer�nl
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: p ate`
PROPOSED IMPROVEMENT LOCATION:
Address: /o7S -&;1A antL T'e2L;
Property Tax ID #: 93.)zi-- W1 - 0002, - (9/6; _ Lot No.
Site Plan Name:
Project Name:
I; DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank
1,"Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ f ova
_ Gas Piping
Sprinklers
_Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: —Sewer _Septic
Block No.
Windows/Doors
Roof Pitch
Building Height:
.OWNER/LESSEE:
CONTRACTOR:
Name JCCOA V.hi�iAluSI-
Name: RS (fd
Address: 8&-K- -U'ih OPS %rav/
Company:
City: r-i` ACC ce- State:FL
Zip Code: 3'(4 Fax:
Phone No. .. // - 9/V-13
E-Mail:�7ae IrrvclJcili t"iWYai�,fte�
Address: -co, 1
City: tqr.-Ce Stater(
Zip Code: 3ygYS� Fax:
Phone No 7
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_I
E-Mail 717-c% f ulaw-&0 tnr rclMmA
State or County License CPC 1 J-(.S78Y3
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.
F-11
SUPPLEMENTAL
CONSTRUCTION LIfN IAW iNPORMAT10fV
: '
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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 conrict 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."
Signatt.V4of Contractor/License Holder
Signa re of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `N
COUNTY OF Sal • V o��c
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledW before me
this\5 day of 1ST t.`_s 20-4 by
this VS day of 0, e ( iA 20V1 by
Faso n %�t,�'� W•\liarr,5
SA saw J� W" -rn N
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 tF \
Produced rr"t— � L
(Signature of Notary Pu ic- State of Florida)
(Signature of Notary Pu lic- Sta ENS
S
Commission No�CrOa� dui EVN`N pea
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Commission No.
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Hev. 2/ // 19