HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO
��MUST BE COMPLETE'
Date: q ^ %ISA L q
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578
PERMITTYPE:
Address: :1, Qk_ Qcc'4L �
Property Tax ID #: 130 \• Ln0'l -
Site Plan Name: Ln \d.P VJ 007'
Project Name:
DETAILEDDESCRIPTION OF WORK
CO NSTRUCTION'IN,FORMATION:
OR APPLICATION TO BE ACCEPTED
Permit Number: III U C O L/
SCANNED
BY
St. Lucie County RECELVEt�
Building Permit Applicatio1j, a I tots
permitting oe" im"t
St. Lurie County
Commercial Residential_
xU41
Lot No.�
Block No. - m�
Additional work to be performed under this permit- check all that apply:
Mechanical _Gas Tank _Gas Piping ,Shutters Windows/Doors
ElectricPlumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: (Q0` 1 1 Sq. Ft. of First Floor:
Cost of Construction:$ IMo 310 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:.:
CONTRACTOR:•:
Name lid C
Name:_ k9J0 LQ_ �yusv�e�t e .
�t,,
6b
Address:33d�etiotV+.� �'J�.16(
Company: ls�7J LLC-
City: State: _
Zip Code: a`7L4(Q feii33fo-ala-
Phone No. i`1a-1-(53-LA L{7j
Address:3300 CYTiQNc\Poe-Ste, to l
City: ro 1 state: N -
Zip Code: a)L(,(C_ `. 3(0- ;i sxck
Phone No
E-Mail:
Fill-in fee simple Title Holder on next page (if different
from the Owner listed'above)
E-MaIlkarho
State or County License-[I?::,C.
it value of constractlon is,125UU or more, a HhLUKUt:U Notice at commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
� 33d
SUPPLEMENTAL CONSTRUCTIG.�-LIEN
LAW,INFORMATION71-
.-
__
-
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
?C_ Not Applicable
BONDING COMPANY:
Name:
__YNot Applicable
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 Countyy 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 thejobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of caner/ Lessee/Contractor as Agent for Owner
Signature o ont ctor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA -
COUNTY OF
COUNTY -�,e_
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this FS.dayofZ-� 20�R by
this _S!_day ofNp17N<a_%J 20-aby
Name of person making statemen .
Name of person making statement.
Personally Known OR Produced Identification
Personally Known 237558Type
_
of Identification
022Produced
Type of Identificat1::=3
Produced m'1�
(Signature of Notary Public- State of klolda j
Signature of Notary Public -State of FI •6 j
Commission N ;' "• ''•• KAREND'O 0
.: ISSIOf 237558
. :o I1 KAMYONOF
Commission No.�is'.�;ii•eaINYCOMMISSION#G
o,•' EXPIRES:August5,2022
�;.. •• EXPIRES:August5,
v, oPp
REVIEWS
FRONT
ZONING
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MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
DATE
�� II
RECEIVED
l
DATE
COMPLETED
Kev.9/Zb/18