HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
Date: 5 a 1k
FOR APPLICATION TO BE ACCEPTED
Permit Number: \ Ckd 5 -d 5375
Building Permit Applica ionM" 21 2019
Planning and DevelopmentServices - 5L• ka� p count
Y Permitti
Building and Code Regulation Division --
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ] ,— Residential X
PERMITTYPE: r\ Y\ bV\ �- A�-No JakNo V\
PROPOSED IMPROVEMENT LOCATION:
Address: a?00 M W W1pJTjgg5 C2EEk Qr
Property Tax ID #: qq Sib - Odb 5-- Oda,O Lot No. is
Site Plan Name: `ZO Block No.
—r
Project Name:
DETAILED DESCRIPTION OF WORK: I
/A1TF_JIZ1DJ2 )Oj5:iVotJi4Tlr ANO PbIQCN %;V17t7/
/NCI-010I it Court"'M 4/00
CONSTRUCTION INFORMATION:
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 Pitch
Total Sq. Ft of Construction: 5"500 Sq. Ft. of First Floor: 5$bo
Cost of Construction: $ 000 Utilities: _ Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name DFNNIS GYLE
Name: LEranlW90 BAL.ixYLE
Address: (_�)t►1 kJrp7i g CQ f-Y- /L
Company: $aLApDlLT Cops—(IM Af(�
city; 021,P1 GL'ry State:,
Zip Code:.z 6 Fax:
Phone No.
Address:-91 Al f2==l1IER W
City: �T. d112.•-f` T State:- FLI
Zip Code: ' 1-067CO Fax:
Phone
E-Mail: - M
Fill in fee simple Title Holder on next page (if &Yerent
from the Owner listed above)
E-Mail A iN
State or County License
u value or construction is y25ou or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SU-PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: JC Not Applicable
Name:TF, !TCHL.IX
Name:
Address: l �1w►D►-0,J &UMe SCOV B-leis
Address:
City: %IF -A A CA64+ State: _FL-�
City: State:
Zip:Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:__.Not Applicable BONDING COMPANY: ,XNotApplicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association bylaws
rules, or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENC ENT."
-Owner/
Sig ct ice a Holder
Lessee/Canty a as Agent for Owner Signature of CrOREIDA
STATE OF FLORRIDA STATE OF F
COUNTY OF 1$ rOwacJ m4e--r )
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2—"ay of (T 20 11 by this * day of � 204tJ by
D Worms L . l-Y(2c
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 joqntification
Produced Produ M VL-
(Signature of Ni? b ate f jlgtgjgitateofFlorida ture of Nota ublic-State 1a jj
Michael J Pawelczyk COMMI9sI0N#FF9831o0
t �y
Commission No. Mr camrtyts G194842 + ` RES:Mai `14,2020
y`crn xPire'08l� 2 Commission No.3 rq -ZC a2 S '
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