HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA �IAPP IETED FOR APPLICATION TO BE ACCEP
Permit Number:
A 717M ez" SCANNED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
t5y RECEIVED
Building Permit Application AUG 0 8 Z019
�T i icie County, Permitting
Commercial Residential )�
PERMITTYRE: Kit-
Cot�j��,f -TO�J
Address:
Property Tax -ID #-
Site Plan Name:
Project Name:
&' �A I
D
07-- 60:5 - 001 (' - (200 -
DETAILED DESCRIPTION OF WORK:
T WaLF
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:-
%
Lot No.
Block No.
V Mechanical
GasTank K
Gas Piping Shutters
Windows/Doors
'h-.1"_
Electric
V.- Plumbing
Sprinklers Generator
3e—
Roof 5 Pitch
7-tI'l-AG.
Tbilw-
TotalSq.Ftof onsfruction:
Sq. Ft. of First Floor: _Aleo_a�
Cost of Construction: $
Z6 g I
Utilities: — Sewer 2- Septic
Building Height:
OWNERAESSEE:
�CONTRACTOR:
Name
Name
Address: 11615� VINVP�4_t WPLi
Company: W\&=6) I 0^4A&4W I I Ci
city: WX &I. L_JC,JT_- State: F-
Zip Code:3H 18 J� Fax:
'Phode"Mo. _01 "D7�e (009
Address-�142"Z' VIIJM6f iiil-j
city:116114- �1-. Stat;.Tu
Zip Code: 3 Y5 e 4 _Fax:
Phone No -1-71� S7Z tool
E-MalI:_f1Ar,&k�6V\%JA 4`5e CO v�\ 00 S� - r,4
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail j%A G,-,�yl 4S'8
COw<aIS4 -
State or County License Ocni(/ (7�VS'Ln
I cooQTf #ju\r.%6fyu -z-z,'B1-
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
if value of 14VAC is $7,500 or more, a RECORDED Notice of Commencement Is required.
G:: > r), 9 \
;UPPLEMENT4L CONSf 2 _J.10N LIIE,N LAW I N1170
, I
RMATION:i^,
I
--a
"IG ER/ENGINEER:
Name: M2L- rj
Not Applica ble
�4
MORTGAGE COMPANY:
Name:
Not Ap plicable
Address: 196-4 SLJ I
af: S r -"Ilq-
Address:
City:
Zip: f i-T-71N Phone 777,
State: —
5�Ltf 54) 1
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
'Name:
__XNot 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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in co Mict with anxia Scov na hat st t oc on it uc
hilicable Home Owners Associartfort rules, bylaws or an e ntst may. re tic pr ib s h
structure. Please consuftwi your Rome Owners Association a.ndreview your deecr, for any restrictions which may appl�.
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'Cocles 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 IMPRO11FEMMERHS TO YOUR P-1119PER�T. A NOT11CIE OF �COMME�MENT MUST BE -RECORDED AND -
-,PdsTEb-.-ok-tHE,a.oB.�.srtE-BEFo.RE TtiET.iRsT-ANspEcTIOYL.-IF�.YM.IUTr-ND I TO'DWAINAUIANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature ofQ)vner/ Lessee/Contractor as Agent for Owner
�fgnature of Cdq*actor/License Holder
STATE OF F1.40RIDA
STATE OF FLORIDA
Courray OF (21 if,
Coomn GF )o, I e,
The ing instru ent as acknowlecIppbefore me
this !rday of 201_4 by
The f oinginstru ent was acknowledgeA before me
this 7 day by
of 20_j`1
L 'it) Jc:, �
N) Ol I ) [P�AAfj
R t�,
VR t �R LeL�
Name of pe son making statement"
Name of person making statement.
'Personally'.KnoWn
',Personafly.Xnown
nRi-Rroduceffidebtifi6ton
�OR Trodbced Id6ntification
,Type &Iclervrj��
Xype ofilded'dfijr
Produced.
Produced
EE� A
(Signature of Nota
5tatekot
P�tt�&n ALON.)NIELSEN
-
(Signature of Notary P
NIEL9EN
AState of Florida -Notary Public
State of Florida -Notary Pu lic
�=St blic
Commission No.
commisso glpG 207484
Is
y Com issi n Expireg
Commission No.
Com*f*04 GG 20741 34]
June 12, 2022
My Com !salon Expires
M
June 12, 2022
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Rev.27770