HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICA16LE INFO MUST BE COMPLETED FOR APPLICATIONTO-BE-ACCEPTED
Date: �sl i 1 . SCANNE®Permit Number
BY RECEIVED
:,=°w St.LucieCounty
awmewd"�wV00 AUG 15 ,901.9
qmmomminlimmimmo Building Permit Applica ion
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 X—
PERMIT TYPE: lz&- foDr-- ,
PROPOSED IMPROVEMENT LOCATION: �-
Address: 3 o 3-i' M EML) AAA LA- i e fb2?- FI E2[`_F_ l-L 3 V 5 R
Property Tax ID #: a `r 7 V - '�Dc>L - - LX)U -
Site Plan Name:
Project Name:
DETAILED DESCRIPTION OF WORK:
S�V7� -t m& uptr!E?�Ack
I N574�L, l-tft\?Afx- s lun 1,? &+f-T-
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
Mechanical
_ Electric
_ Gas Tank
Plumbing
Total"Sq: Ft`ofiConstructiorn n:
Cost of Construction: $ 0I9(080
_ Gas Piping
Sprinklers
Lot No. as
Block No.
_Shutters —Windows/Doors
_ Generator � Roof � Pitch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height: i
OWNER/LESSEE:
CONTRACTOR:
Name
Name: UI A) DAJE-5
Address:
Company: PLDFS 4 66MMAL NAJT,('J7
City: I PrL(L State:'F(,
Zip Code: — Fax: n
Phone No.}a 541 -�(l�
Address: ?CoS$ k'JP &-5' I41,
City: F(1e T i r1'C � State: F1-
Zip Code: 3qC) L/S Fax:
Phone No'4' a LILI U /13 cy
E-Mail: Tk 6-1 P-L%9-)-y0 R R 60M
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail i n f0 & 12-00fs B /-F / A)0 , N/A
State or County License j2CC- / 3 ,-1 /�/ 1a
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: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 Countmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conIct 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 o on ractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA
1UG c
STATE OF FLORIDA �} / I i� �• r,
COUNTY OF
COUNTY OF
The forgoing instru nt was acknowledle�t
this day of 2%..
�r
The forgoing instru ent was acknowledged before e
this day of 20�9 byn
U ?J�O�-
D
/S /�E 'A
Name of person mak g statement.Li
Name of person m 'ing statement. ,Nq, o mg
Personally Known � OR ProducedPersonally
Hug
R
R��B
Known>< OR Produced Identificat' nType
of Identification
Type of Identification
Produced
Produced
C
(' nature of Notary Public- State of FI rida)
(51kdaf6re of NotaryPublic- State Florida )
Commission No. 3G;U � ( T, � (Seal)
Iof
Commission No �CT fl(OZ6 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.217119