HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- -,� __G -- -1 —
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All APPLICA�q!.E INkO MUST BE COMPLI 'W FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: C&
BY VIECEIV50
St. Lucie CountY MAy 2 4 1019
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PerM%t,L1ng DOOO '�e
Building Permit Application St. 'Cl, Count'i
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V/
PERMITTYPE: QCIAC)0-1�
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID
Site Plan Name:
Project Name:
PTION OF WORK:
CONSTRUCTIOWINFOR-MATION:
Additional work to be performed under this permit -check all that apply:
—Mechanical Gas Tarik Gas Piping —Shutters
Electric —Plumbing Sprinklers Generator
1W M�n I
Total Sq. Ft of Construction: -I= L/ Sq. Ft.. f First Floor:
Cost of Construction: $ 5DCr Utilities: —Sewer _Septic
L "-No.
ot
1lock No.
—Windows/Doors
AARoof 5'112� Pitch
Building Height:
�OWNERAESSEE:
-'coNTRACTOR:
Name
Name:. T41-214no�As ry~
Address:
Company ry-
City: 4050,-bm State:EL
Zip Code: Ij 4kq 5 pax:
Phone No.
Address:
City: I State:.EL
Zip Code: S:) Fax:
Phone No 5( v i - % 5
E-Mail: (Siro'
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Maill 4rVk5nL'4rt3uy-eA anc:4
State or Coun License-01 OnC- nr�� 42;
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
Ii value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
I
SUPPLEMENTAL CONSTRUCiFA LIEN LAW, INFORMATION:
DESIGN ER/ENGIN EER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: A
Zip:
City: — A ) / 74 State:
Zip: Monk:
FEE SIMPLE TITLE HOTER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address:
Address:
City:_
City:
Zip: r 111fione:
Zip: Phonb:
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 gy THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOM LENDER J7R AN ATTORNEY BEFORE RECORDING YQdR NOTICE OFCOMMFNCEMENT:'
Sr'Vf Ownressee/Contractor as Agent for Owner
g atu of C/ tr or/License HoTder
:R[��
STATE OF FLORIDA
ST TE I( ID
COUNTY OF f5k- Lu c� e-,
COUNTYOF C,
LLt6
The f �ing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
�Aruj
thIs7dayof k 20 JI?by
AAA -7
this:223dayof 20-0 by
1
Ara�n rc>c,)
Name of person making statement.
making statement.
Personally Kno n 1,1�01514rlduced Identifii cation
Personally Known L,-'OR Produced Identification
Type of ldentiZc'atio�n
Type of Identification
ro uce
Produced '-7
A
'Sig
' (Signatur Yf t ublic- State of Florida Yl/
igna 0 t ublic- Stite of F0146)
'4 E ME CGUITMEY
� Vulr.,, .
_`nv4 Ission # GG 115298
Corn . . (Seal)
P*
P DEBORAH RAE COb*TNEY
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TU RTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 217119