HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLr'itJ FOR APPLICATION TO BE ACCEPTED
Date: 6^ �r(�— SCANNED Permit Number:BY
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- St. Lucie County
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Building Permit ApplicatiN t z ti"
Planning and Development Services ag/\13J318
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: IO ST l S OCEArJ P& "'r 31
Property Tax ID #: ti511 - f310- c0315- 000( 3 Lot No.
Site Plan Name: /U
Project Name: M t WE=�
Block No.
I DETAILED DESCRIPTION OF WORK: I
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- 20 lzo ScvGca , 3r�` Couaw.� 2A1LS 1 `7ili
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: Sq. Ft. of First Floor:
Cost of Construction: $ (/ vJ c( 00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i
Name: /l41&k% gz-
C-,.Vo0Ww'J
Address: 109i1 3 ocew Da- Ldr ?I
Company: 70nu1rmTl
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City:-3OnK-� 9CVX- + State: FL-
Zip Code: r 744 f!f� Fax:
Phone No.I nfl 47.< - gy-Ir
Address: / Alv
City: S)va.�br
Zip Code: 34SR y
Phone No l
tate: a2
Fax:
92 �oo-f-o
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 412
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State or County License
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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 CONSTRUCT LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Fw7aoa #wmmuM A1v&AiW4Af10 Name:
Address: S'•YM40 M"100L lineBi,6arrirllo Address:
City: A State: City: State:
Zip: 136og Phone ; Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip:
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 Coun 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 rom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fence w igns, screen rooms and accessory uses to another non-residential use
"YARNING TO OWNER: YOUR FALL RECORD A NOTICE OF COMMENCEMENT MAY IN YOUR PAYING
TWICE FOR IMPROVEMENTS PROPERTY. A NOTICE OF COMMENCEME M E RECORDED AND
POSTED ON THE JOB ffE THE FlRST INSPECTION. IF YO T T NANCING, CONSULT
WITH YOUR LE E A EY BEFORE RECORDING YOU O OF ENT"
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Signature of wner Lessee/Contra r as Agent for Owner
Signature of 'Contractor/ ense Holder
STATE OF FL RIDA
STATE OF FLORIDA
COUNTY OF "C1E
COUNTY OF /yC4-15-
The forgo' instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thiszAof ZZdX 20Z-2 by
this of_L V 20Z Pby
Name of person making statement.
Name of person making statement.
Personally Known L I OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Producceed!�
Produced
(Signature o Notary Public- State of Florida
(Signatu otary Public- State of Florida
Commission No. :'"'•"• := � � T �tq
Commission No. ,• •.; 4ftlill)MUMOND
EXPIRES:December7,2022
MYOOMMISSKIN8GG489714
7,2022
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Rev.217119