HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
SCANNED Permit Number:
BY
St. Lucie County
Building Permit Applicai
Planning and Development Services
Building and Lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
1NPROVEMENT
Address:
RI C FEF I V �
MAY 143 2019
Permitting Departm
St. Lucie County, I
Residential
Property Tax ID#:_ o�1i30 S1. — C)o 1 — 17d0 Lot No.
Site Plan Name: Block No.
Project Name: MC^\(5Y eC2k�
I DETAILED DESCRIPTION OF WORK:
�Obc nCLA;� slab 46 ex;31_;ng hol)Set-ir-r-l(
Ins ('Oxt,c4m,, IJ)lLvl C'/ i vi
Nt
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction:< , ®i
_ Generator
Sq. Ft. of First Floor:
r
Windows/Doors
_Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Anje-C ZVq
Name: � ii1CCrTi- C(ZflCO
Address: 3a 8) 'MCn+ n' Lie
Company: f-ran cp t0r5+f'1 CF LYI-Tn C
City: 47(3f* � tinrrce State:V C •
Zip Code: Fax:
Phone No.
Address: \Ult N E , IV6
City: -:Y(�en &C. CA, State: EL.
Zip Code: 34c 5- 1 Fax:-1'la-loci' 6 aad
Phone No 331-4- Okl>.'%
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail_SerV i LBQ-Cranco C4DrS-}/ ac�;,y��nC. CD/n
State or County License CGC. I T I at%
V... j aonxrucuon is ;)zouu or more, a KeeUKULU Notice or 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: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or ree6dline vour Notice of Commencement_
Signature of Owner/ essee/Contractor as Agent for Owner
ignature of Contract r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �TA. Ny-)
COUNTY OF Y'W 4 t\
for
The oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of V-e h f i� 20 1°1 by
this day ofC/p_ 201�1 by
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally KnownO—OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
—
(Signature of Notary P
i;rfte ® �I UNSKI
(Signature of Notary Publi F
9 n'=_
_.; .. Commission # FF 926792
.: r Commission # FF 926792
Commission No.
�' a Expiiesde 13,2019
Commission No. y ExpirOcter 13, 2019
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