HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ' 1
Date: / / SCNNII'it Number: `1 I
St. Lucie Coargy RECEIVED
Building Permit Applicati n. JUN 2 4 20)9
Planning and Development Services
ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROP05Eb."MPROVEMENTLOCATION:
Address: qR0 77 2Quli & 3e
Property Tax ID#: TZ/7� 900 0007 000 7i Lot No. 7
Site Plan Name: I-C/%r/V i/d(do 60 Block No.
Project Name: 1_ ?i1,eu/0Qp
CONSTRUGTI,ONINFORMATION-: '
Additional work to be performed under this permit -check all that apply:
Mechanical Gas Tank _ Gas Piping Shutters - Windows/D rs
YElectric 7Y Plumbing _ Sprinklers _ Generator _ Roof .5 Pitch
Total Sq. Ft of Construction: Z 7,73 Sq. Ft. of First Floor: 2,7%3
Cost of Construction: $ �1 50 ®00 Utilities: _Sewer Septic Building Height:ILL
OWNER/4E5SEE:
CONTRACTOR:
Name/SA F�/Pcio2r �F'�7i%dr✓Oda
Name:A / /
L k/J
Address:
Company: li m)6 6d
Pi✓ waxl'es �
City: 'dae"e, Stater
Zip Code:,35'ftt Fax:
Phone No. '/72 7,01 :? Z S6
Address: 00 7'
City: K1 .P/!Gl
Zip Code: 3
Phone No ?i c
State:f�
Fax:
O
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail )j114 b.4 09
104444) VAie& ,Cl�
State or County License t4Li[9
/ Z. $`3/ 5fL'
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 LIEN LAW INFORMATION:
yam,.
.,
DESIGNER/ENGINEER:
Name: � On N• S`sv�rf/ _
_Not Applicable
Q/ .
MORTGAG OMP Y: /
V
Name: � d',
Not Applicable
l/7� v
Address:iTivDiaN
�2w
Address: Do
d
City: p/ �o rhordcL
Zip: 306t, Phone -7?1i
State:
55-r7 3&o
City: I—Q2 'V'9 /
Zip: _33 n3 Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not 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 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 CO MENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YO 1 (TEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN AAORNEY BEFORE RECORDING YOUR JSOTICE OF comMF,NCEMENT."
'
t
V/
/
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signatur&of Ctintractor/Llcens6 Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF STLvI./�
COUNTY OF S�L//iilc
The forgoing instrume t w s acknowledged before me
V Z
The forgoing instrument was acknowledged before me
this lit day of �l 20[ by
this7�day of 260 by
��vlD (e11P.�
,7)N411/) 0/a�Vv'./
Name of person making sta ment.
Name of person making stat ant.
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced -) I n
Produced
r
�t
(Signature of Notary PL
ZULtote pf Ilodda I - - -
(Signature of N ub ic- State of Florida )
KAA S. NIELSEIN
-�'�'p�"0�%'s State bi4�Urida-Notary Public
Commission No.
Commission N `��REN S.
Commission # GG 207484
a of Florida,EN
?:, Commission Notary Public
%+ eP M` Commission Expires
�,
Jun
12. 2022
ommission E
u
VAN
REVIEWS
FRO
PLANS
V G
L$02
OVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
RE
W
DATE
RECEIVED
DATE
COMPLETED
ev.