HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-4 � Permit Number: Oq- GO-1c7Ct7'OG NED
BY
• St. LUf:Ip.Colimv RECEIVED
Building Permit Applicatio
Planning and Development services S EP 0 b 0019
Building and Code Regulation Division ST. Luc
County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: S 610-r- �1not aV tq C
PROPOSED IMPROVEMENT LOCATION.,
Address: H I- L✓ C Gl r 4r aS(— 12:!K�r I06r,4 ef )-L r3999?-
PropertyTax ID #: �wlq - SI b . 66 I °� Ofx�"a Lot No.�_
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION, INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: l Sq. Ft. of First Floor:
Cost of Construction: $ —a,, ois 0 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
.
'CONTRACTOR:
Name
Name:. tl
AddrenS., LA l E. XPVNU* #�/e
Company:Grsg✓ IM�¢ SG(CZtr
City: P6 r-A S4 • L_UZAC. Stater
ss: �" i) (Q ih Pl r'Vo- n42 %
Addr-e(
r
City: I FCG k 'T&It3"o state: Pt —
Zip CodeQL4 q1 S'L— Fax:
09 - (i-- f
Phone No.//
Zip Code: Fax:
tam
E-Mail:I�ttGNYr'NI Rd(aa1TLa?(•rn/v-1
Phone No clLfl- LA(eg- J( 6(
Fill in fee simple Title Holder on next page ( if different
E-Mail t 46 O1r.4
State or County Licen
from the Owner listed above) �•
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. 3 ) 3-61
III
,SUPPLEMENTAL CONSTRUCTION LIEN LAW,INFORMATION:
a
DESIGNER/ENGINEER:
Name: G
Not Applicable
S
MORTGAGE COMPANY:
Name:
_ Not Applicable
Addres :
'ok!&_M
Address:
City: o
Zip: Phone 2 -
St e:i L,
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
%ONot 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 of'Owner/ Lessee/Contractor as Agent for Owner
Signature ofContractor/License Holder
STATE OF FLORID / /
COUNTY OF f� IE�I-OUSh
STATE OF FLORIDA
COUNTY OF 4111 Xnucc_\IJ
The f r oing instru nt was acknowledged efore me
T
The forgoing instrument was acknowledged before me
this day of a . 20_by
this" S day of �{ 20_4 by
Gant /
SIK:NO kk1(eN
Name of person making statemaht.
Name of person making sthtement.f
Personally Known �� OR Produced Identification
Personally Known Q OR Produced Identification
Type of Identification
Type of Identification
Produced Al
Produced
Notam Publie State of Flo
atu of Notary Public- Stat I a )Janelle axwe '
(Signatu f NotaN Public- State of)IdFi Jared Atlrennan
a a My Commission
g p� My commission GG 3423
08/Oa12023
NO. Ir/�� 9 nC a6rt3Ra23
Commis l
EX Tres
On k.
O s n No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19