HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABq INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c C t Permit Number:
noc - Gads
SCANNED (9a660 RECEIVED
_ St. Lucie Colulliding Permit Applicati n AUG n A r9
Planning and Development Services ST. Lucie County, Permlttinp
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: S
Address:
Property Tax ID #: F 3 L/i L/ - SO I -IL/ % Z Lot No.�_
Site Plan Name: �7 Block No. z
Project Name: e 1'��es f ywe_ - &r f- r Qil ✓i w I gyjP )
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters X Windows/Doors
i� Electric �&llu�
_ Generator
K Roof
Pitch
rumbbiing��.� ' ^_UTiSprinklers
Total Sq. Ft of Constructiion:;iit 1 L-51F Sq.
Ft. of First Floor:
7SO A2�
Cost of Construction: $`rfl d o Ooy Utilities:
—Sewer Septic
Building Height:
�-Qd
(�
OWNER/LESSEE:
CONTRACTOR:
Name n d
Name: 'I
JbiSIAX(l OLAM
r
Address: 7-':J N& .Sorllil Warner Df
Company:
City: 0-pado State: IF(-
Zip Code:.2A9Fax:
Phone No. JJQ- 148(q-I Jqq- JL In r ell
Address: _+ KU SO(-�h Warner- Dr
City: 'V;EV)XP71 $eh State: Ft;
Zip Code: '�`/9S�- Fax:
Phone No 9- 49-
E-Mail: V� I e� 'Iy 111$ck (@ Qw � � CC) r'
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail `A) I S1AL1I
IR� QYnQ_1'
, C
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: 1 _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 9)'E A CCIA-i tee+S Name:
Address: 130 61r Off; _0 A 5� Address:
City: 5i a ar l State: FL City: State:
Zip: 3�i� Phone 722. 28T'�.3tR� Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature f Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF K6p-TtA-)
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -7day of AUGvST 20B, by
this _ day of 20_ by
JOkFTI U I,)�swe1,l
Name of person making statement.
Name of person making statement.
Personally Known ,/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
s_L 's
I
./V
( ignature of Notary Public- State of i
�WIoosTa�oa
ignature of Notary Public -State of Florida )
GG13.3412 �'
Commission No IE M �'d
CONNCommisslon#GG133422
.:'�_
Commission Na. (Seal)
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