HomeMy WebLinkAboutBUILDING PERMIT APPLICATION`All APFLICraBL NFO MUST BE C0MPL6 ri1) FOR APPLICATION TO BE ACCEPTED
D�te: '� n 1� I�d Permit Number:
�V SCANNED
St. LucieCounty
Building Permit Applica-
Planning and Development Services
Building and Code Regulation Division
2300 Virginia.Aveni e,fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE: Sing(c PROPOSED IMPROVEMENT IMPROVEMENT LOCATION:
RECEIVE®
Jon AUG 2 9 Z019
Permitting Department
St. Lucie County, FL
Residential
~IIProperty Tax ID#: 3LllLI—SOI—IOqc)R-2- 0A Lot No. g
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK- --
CONSTRUCTION IN
Additional work to be performed under this permit- check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters
jC- Electric )C_ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: a) to S' ( Sq. Ft. of First Floor:
Cost of Construction: $ Ac>o 1 Li sl Utilities: _Sewer Septic
Windows/Doors
)k Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Toh.r- 14. 4Tiv
e--
Address: 11 52- 5LJ CL'-rHS
Company: za
g ;Iders' TG n•
r�
City: Par+-S4.La_cie State: r�,
Zip Code: '3yQ$'� Fax:
Phone No.
Address: 5-It SVf PSL
Alcfd-
City: Pai-f S'f- Lar-Te- State: FL -
Zip Code: 3t44S3 Fax:
Phone No 7'12• 33(p-71a/53�/"
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CD
E-Mail r1�. a
rD91wf7� ;l d-01(f . C'av—
State or County icense
C GG
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.
q any
Sl1FPLEfV]ENTAL CONSTRUt
:rc..�
FCVN LIEN LAW INFORMATION. �
DESIGNER/ENGINEER:
Name: /:kris P3?X1 S
_ Not Applicable
tJa.(—Tec,l'
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: ItDHo
Dr&*K e.
Address:
City: P wAti &&- 6•
Zip: :*;13V3 Phone
State: F I.
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not 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 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."
Signatur/fOwner/ Lessee/,C9UYry0fOwner
SigAYture of Contractor is se Hold
STATE OF FLORIDA
OF S�LtAC�e
STATE OF FLORIDA
COUNTY
COUNTY OF .S�rWC1C'
The f r oing inst ent was acknowledged before me
The forgoing instrument was acknowledged before me
this day of , 2011 by
this ZM day of .Suyl 20 lg by
jolln �Mhony (-arDzap
Sohn Anyruc M 6rozo,_
Name of person making statement.
Name of person making statem t7
Personally Known OR Produced Identification
Personally Known _, OR Produced Identification
Type of Identification
Type of Identification
Produced
9"
Produced
�
(Signature of Notary lic- State of F
ature of Notary Public- State of Florida
Commission No.
.,&' BRIANNA GRAHA
WCOMMISSION #GG
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fission No. 6 7 c)16q 10b
y„� BRIANNA GRA
My COMMISSION #
EXPIRES: APR 02,
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21
EXPIRES: APR 0
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
`
DATE
COMPLETED
Rev. 2/ // iy I I