HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q n
Date: 9117 20 /9 Permit Number: 1 I O I 'DDDs—
SCANN Y RECEIVED
• St Lucie Counter SE? 45 2019
Building Permit Application De artment
Planningand Development Services ?ergl I19 p
P .. i ude County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMITTYPE:
PROPOSED;IMPROVEMENT,LOCATION:
Address: Rj%o pLyqrV-Ai/d/V % t4jeES (`pUF_ P02T ST. uc-If•, F4 34
Property Tax ID #:
Lot No. 2 t
Site Plan Name: Block No.
Project Name: JZA S 4-1 /30 T/fit 'Lf k/I Sd'F /` ZSA726t 140li1'E
DETAILED. DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that apply:
rA
_Mechanical
>Gas Tank
YGas Piping
_Shutters
—Windows/Doors
_ Electric
_ Plumbing
_ Sprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ° a-vu
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ICASd1�tlQ! l ils �}( �PJ�T�lI
Name: 8 V/1/ 'm%— 0
Address:
Company: /3 i N P14 h
City: dod/L-i Sr- LLr tl State: a
Zip Code: gee Fax:
Phone No. � - Cl 7 64 4Fr
Address: 7 3/ 41,/
City: PUs+-T Sr. Uc/f State: X:-L-
Zip Code: 3 9 b' Fax:
Phone No �_-
LL�71 �-7
E-Mail: ik bq&,,t, o pe-.,)viom
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.
SUPPLEMENTALICONSTRUCTION LIEN.LAWIINFORMATION:
DESIGNER/ENGINEER: _ _Not Applicable
Name: kASNan IQ I L- RiAT/zfl,
MORTGAGE COMPANY: Not Applicable
Name:
Address:—�
Address:
City: fi cit
Zip: 3tZ ,? •Z Phone
Stater
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
� otApplicable
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 County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contYlict 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 of Owner/ Lessee/Contractor as Agent for Owner
Signattuu`re�-Contractor/License Holder
FLORIDA �� L C�
STATE OF COUNTY
STATE OF ORIDqS
OF
C UNTY OF
The forggQQl1 �ggsstrum nt was acknowledge efore me
The fo ' instr nt was acknowledgeAbefore me
this 2t:ilay of 20 by
thi�i ay of 2011 by
F}5hmtiri �C>\
'-E)y-CkC1LC J aQdd,Q.�
Name of person making statement.
Name of person making statement.
OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of IdentificaY
Type of Identification
Producedl" L." I
D�
Produced
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(Signature of No i - State of Florida J
(Signature of Not lic- State of Florida
Commission No.?A'': T�dVFdf1LLE
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Commission No. ANY
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