HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
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Date: yl=sll—� SCANNED Permit Number: L-
BY
St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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Building Permit Applicatit�, 0?
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Commercial Residential
PERMIT TYPE: 1ZtRao� CFIFit QDOF)
PROPOSED IMPROVEMENT LOCATION:
Address: qls I ur-LVe bet,2
Property Tax ID#: 34oL(- 5o1- 054i0-(90o-u Lot No.
Site Plan Name:
Project Name:
Block No.
I DETAILED DESCRIPTION OF WORK: I
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 211:a Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ � 511 (
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Z-Okn
Name: 61%,1h15rM 8 1cdWAt'0. f
Address: GIB 9ACxa'C*—k,/C
Company: c i/ rfyl %P�try7 pffiflkurhoyl
City: FbO fiem_(1 State: EL
Zip Code: 3N9Fa Fax:
Phone No. 77D-W0e�0-324
Address: 4/0 iD c 14S HWu l
City:�'Mplcle State: FL
Zip Code: 331/7"7 Fax:
Phone No 7YO -a7tf 3ODLi
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License 0('(113aiys"/133/ys/
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:
UtbIGNtK/tNGINtEK: ZS, Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
_
Zip: Phone
Zip: Phone: 71
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 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF F�(wl ( dGG.
STATE OF FLORIDA
COUNTY OF (tea (w3 18a'dciL
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this ZF day of &—,-, ( . 201,9 by
this ZS clay of Aff, I , 20LI by
alll;'w B. Edw,yds
AoalIttlaw Y. E41404415
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
(Signature of Not@
(Signa r' j
M Z Notary Pub lik State of Flodda
Commission No. Chades Kr�sljittman
Notary Public $late of F10RdpSe
AN
Comml i Charles Kevin Pittman 11
n.33
y r My Commission GG 303971
1awwP Expires 0211212023
My Commission GG 30
ftw Expires 02N 8Q0i3
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
MANGROVE
VEGETATION
SEA TURTLE
COUNTER
REVIEW
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19