HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO LMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: /' Permit Num Pr,
9 ®O RECEIVED
•ISO St. LUde000* JUN 19 2019
-- Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie,C u nty, FL
2360 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: Jc� v-'�_ GCd yam_
PROPOSED IMPROVEMENT LOCATION: ; €
Address:
Property Tax ID q: 19433 -1 9 1000S- CbQ-g Lot No.
Site Plan Name: Block No.
Project Name:
CONSTRUCTIONINFORMATION.
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers
Ia Total Sq. Ft of Construction: Ot "Ij
Cost of Construction: $ & - 1 S 00D
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:'
CONTRACTOR::
Name ^J
Name: �
Address:�PD1nr1S2 �l�A
Company: -So
` Mf
City: Fn/r Pie.rez State: R.
Zip Fax:
Phone0413
Address/�:'jg._ISE
City: Pfl/+ St• t...tie. 10• State:F%
Zip Code: 3yCLK-f Fax:
Phone No -7-0 —te -g(3
E-Mail C
Fill in fee simple itle Holder on next page (if different
from the Owner listed above)
`ID`
E-Mail SoJ}1 emSc e�nsr 1d� 2�ntl�o,N a , !, ccsn--'�
State or County License `61a)g
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.
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 COMMENCEMENT."
Si�a ure of w . r/ Lessee tractor as Agent for Owner
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ev.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
-
DESIGN�E1R/EINGI
Name:flor;r/a. �i.M,,l.�
R:
Not Applicable
;rver:,rb
MORTGAGE COMPANY:
Name:
Not Applicable
Address: S�i�,e.110
Address:
City: Fl•
Zip: 331oo°I Phone l3 374-2LW3
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _Not
Name: _
Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: _ Phone:
ctor/License Holder
STATE OF FLORIDA
COUNTY OF si'" LUC,t 2.
COUNTY OF �r LUC I �
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this � day of .�'cran_ , 20 i9 by
this !� day of �Cy'EP . 20� by
�"(�on� Firma-Iric�l�
SGn"1QS �2t�t-e
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 Identification
KELLYMACHADQ •
Produced KELLYMACHADO
Produced
Commissbn#GG004436issan#GG004f36
+afczpiresSeptember 15,2020
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o�rtapires5eptember15,2020
Badedllxu Trml Fain lnsunnse 8003AS7
(Signature of otary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. C,�CTOU�(p (Seal)
Commission No. CA G^��'3(0 (Seal)
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