HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO_-'r;'_iETED FOR APPLICATION TO BE ACCEPTI_u
Date:
SGMNE r Permit Number: I Orl ' q?
Stluce Counfiv RECENED!
ie
Building Permit Application JUCI6, 2o1*9
Planning and Development Services Permitting Department
Building and Code Regulation Division - - St..Lucle County
2300 Virginia Avenue, Fort Pierce FL 34982 ` •' ` `-
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
Address: a&P O() Soura Iwo 1H' a\) RI V eg &CI yid
PropertyTaxlD#: 3Sl9 `501-000s—o®eo, ...2r Lot No.
Site Plan Name:
Project Name: I e reh/ s IQ6-029oje
Block No.
N� . Di° G1�i COnI,tJ(!G%D2S Ale'&) 7iWSSy„$ .✓(,), A.J_
J4N0 Mf! TAG /LooFi;y6
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank Gas Piping
_ Electric Plumbing _ Sprinklers
�dF —' Total Sq. Ft oflConstruction:a.4A Wsg
_Shutters —Windows/Doors
_Generator ZC Roof" 'y':Pitch-
Sq. Ft. of First Floor:
Cost of Construction: $ 34- oQ O Utilities: _ Sewer ?0 Septic
Building Height: 14
ri
OWNER/LESSEE-;
CONTRACTOR:
Name
Name: OG71U 4� R ®dI CD 612
Address: O
fiJbIkJ ftliva A
Company:
City: P11164d
Zip Code:--3 Z. Fax:
Phone No. 9�¢� eZLIP .7
Stater
N P1
3/
,Address :..: .. . ...... • -- • :;.:r
City;;.-, N '1 State:_
'Zip'Code:` Fax;+.
'Phone -No
E-Mail: Nf/9
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
J/
SUP HEMENTAL CONSTiRU L EN LAW INFORMATImolim
ON:
DESIGNER/ENGINEER: _ Not Applicable
Name: PAU1- W3t.CH )W G .,
MORTGAGE COMPANY: Not Applicable
Name:.
Address: l9 $4 5. W . !dl'L'rfAb" hT / 4..
Address:
City: PDXMA Locyq State: Pt.
City: State:
Zip: ,3 IB s� Phone 772 78 - 9 8
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Na '.". ,&uy'. Jj(�✓Q/V _
BONDING COMPANY: ,Not Applicable
Name:
Address$�� S. lNOiA>,J RlVe—A R
Address:
City: f; R C
City:
Zip:M 9QZ- Phone: 9Se�� /
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,Y do hereby agree that I will, in all respects, perfotm 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 fullconcurrency.review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory use's 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 YOURLE.l ' OR AN ATTORNEY, BEFORE RECORDING YOUR'NOTIld OF COMMENCEMENT'.'- - ` •. "` • - • -
aw Q
Signature of CMfier/ Lessee/Contractor as Agent for Owner
Signature ntractor/License Holder s
STATE OF FLORIDA
COUNTY
OF
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this � 1q' day of 20by
6 o Y
The forgoing instrument was acknowledged before me
this day of Q U . 204 by
60 Y auytr#y s
Name of person making statement.
Name of person making statement.NIJ
V
Personally, Known OR Produced Identification
• ' '
Personally Known- - , OR Produced Identification
Type of Identification Produced '
Type of Identification
Produced
Q^
Y1�t
m ka lvY
�3G i1'�ll hwo- i,vP
Signature of Notary Publ - State of.florid ., _
Commission No. ;:::��;,< UISHANNAINGR�•rrMING.
'';: MYCOA,MISuIp 27506U
'�•. a .e EXPIRES:Decem$er•ZO,Zp7L '
a��•` &J(ICed ThNNOIeiY PuNwUnderoTileR
-
PLANS VEGETATION SEA TURTLE .M4NGROVE
(Signature of Notary Publi& State of Florida r4
r-
Commission No. I .:':;%?"°:"••;• IASF(4"V4INGRAM-RAFIMING
' MY COMMISSION O GG 275060
.•
REVIEWS
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FRO
;°•" Bonded ThN N
Public Undennilers..
COUNTER
REVIEW
REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19