HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE vnIPLETED FOR APPLICATION TO BE ACCE�'rr U Q
Date: a10-Z6- /9 Permit Number:
SCANNED
a BY
St. Lucie County
WINE
--- Building Permit Application
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
PERMITTYPE: TenC2
Address: S9O
Property Tax ID#:.��Z—�plO-D�%`z— ODO-Z
Site Plan Name:
Project Name:
CZ) W lozJk- G47ks,
Additional work to be performed under this permit - check all that apply:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ Z,1So ,00
Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: —Sewer —Septic Building Height:
OW ERjLESSE 1 11 11
CONTRAa
Name h MQO 41,rl
Name: / nC�TORi a�;z U.-Or
Address: SroS2/Y1000 !1t�
y
/`,
Company: /10 ✓4.T bn GG Zn
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City �� , /�ie%'�•--�-- J• State.
Zip Code��•3b�%tf',Z� � Faz ' -�•
O�c! l �
Phone. No of ''7Jr7%
Address R O b� !Z?57
_
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;City �� 4TirJ7',P " � ,; State:-,QL
;Zip Code�.0o7i7Tc% HFax:
=P.Fione No -7 eIn/a
E-Mail>'=
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
L
E-Mail [!lam rD I II otJ44T DWG c 6�
State or County License t✓ 15114 d
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 CONSTRUCTii • EN LAW {N
RMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: 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 FPR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE O COMMENCEMENT MUST BE RECORDED AND
POSTS ON THE �B SITE BEFORE THE FIRST INSPECTION. IF OU INTEND TO OBTAIN FINANCING, CONSULT
WIT OUR LEND OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Si ature of a Lessee/Contractor as Agent for Owner
Sig ature of Contractor/License Holder
STATE OF hADWIJA
STATE OF FLORIDA � `�
/-a Cie
COUN //
�GtCIP,
COUNTY OF
OF �y-
The for�°ing instru ent was acknowledged before me
Lf e,
The f�orEoing instrum nt was acknowledged before me
this�S dayof %une 20� by
this! day of 20L2 by
Name of person making statement.
Personally Known OR Produced Identification
Name of person making statement.
1 /
Personally Known V OR Produced Identification
Type of Identification Produced
Type of Identification
Produced
�
re of Notary Public- State of Floridaignature
rommis� ion No. (Seal)
of Notary Public -State of Florida)
Commission No.
#ptp!'"Fr, JAMESA- ETHINGTON,JR.
JAMES0.WETHINGTON,JR.
Ift Notary Public, State of Florida
* *
tJofmy Public, State of Florida
Commission No. GG31
m';on Expires C
04/2023
REVIEWS
FRONT
PLANS
VEGETATION
EA
VE
REVIEW
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19