HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB ' INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �y u
Date:' SCANNED Permit Number:i.
,.. BY
St. Lucie County Fion
ECEIVED
-- _- Building Permit Applica120 2o19
Planning and Development Services
Building and Code Regulation Division r,r county, Permin9
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address: — 3 Lf O q �-k-e n, -C -?-
Property Tax ID #: D $; 702 000 6 Lot No.
Site Plan Name: /Dr*r-K HAtMo e-h L'LWC 5 MeN je^06e2 Block No.
Project Name: LUGrc.
DETAILED DESCRIPTION OF WORK:
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ Vcl S-O Z-
Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name rG c.6 stzu'c-C
Name:
�wt•(rc-L
Address: o pz 016
Company: Et f r vet fi7 c
City: Fort rt-Cc{ State: +
Zip Code: 361r9 Q( Fax:
Phone No.
Address: i' IbC71 5IV &yVrk vk-eecl
City: I &c-eState: a
Zip Code: Fax:
a
PhoneN JKO1�37c,
E-Mail: JS9,At)OVDV5k(- A(GOr,f1yu�•
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Yv bl S tV Fh fe F1,ic'AP.G 4iQ r,
State or County License iz /300 60 M
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 CONSTRUCTION 4WLAW INFORMATION
...
DESIGNER/ENGINEER: K Not Applicable
Name:
MORTGAGE COMPANY: ?c- Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 THE JOB SlITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat of Owner ess a/Contractor as Agent for Owner
Signature Contr tor/ L tense Holder
STATE OF FLORI A
STATE OF FLO
COUNTYOF Sr L,vc1r
COUNTY OF Sr- L,c t
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this I day of -doli G 20 1 `' by
this 13 day of �L) 116 20 I S by
Ji)0.3 e401r" 7—
T01+rf P q P t[ 2A-Z
Name of person making statement.
Name of person making statement.
Personally Known X OR Produced Identification
Personally Known X OR Produced Identification
Type of Identification
Type of Identification
Produced
.µ�,t•.,,•,, KONNI LENAE DEWITT
Produced
`, Notary Public -State of Florida
• Commission#GG 166915
..'..,
;';�w=••J�;:; KONNI LENAE DEWIIT
-
,•,loU, 2pp1
._' My Comm. Expires Dec 10,
=�. �•"= Notary Public -Slate of Florida
• : �'
• Commission # GG 166915
(Signature o Notary Public- at o
(Signature of Notary Pu ic.= "of t a
Dec 0,Assn.1
,,.,,,, ery WOW
Commission No. 1361W0,716- (Seal)
Commission No. U6I(P a qlS (Seal)
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Rev. 2/ // 19