HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COI:,"cTED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: %-'00/7
"DUANNED
- BY
St. Lucie County
! _ - RECEIVED
�- Building Permit Application
OCT:U 1 20)9
Planning and Development Services
Building and Code Regulation Division Permitti Department
St.
ucle County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
P OPOS@D IMPROU = ENT LOCATION:
Address: 13Zl7 Lccnre�,c,e `(eP-fC Ce.
Property Tax ID #: 4Lia(P • �C)4. C01LQ • CC03 Lot No.
Site Plan Name: Block No.
Project Name: InnIL0l,[Ovc.-,LAB
DETAILED DESGRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check. all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
_ Electric _V/plumbiinng, _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Constrf n: J Sq. Ft. of First Floor: a pry 2Sc.rJ
Cost of Constructi� L `l sties: ✓ Sewer _ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name R(C�,,D� i Q 4r : AnQ)am9t �- n Name: Cr - V�r,.,no.l
Address: 3ZG n vcc Company: I p„ne� Cm,�re. 1. o�
City: a AIL ,i A State: El. Address: raz -5 c-, 5-L.- toL ci ✓o.
Zip Code: _/� LI TIT Fax: City: _nvr 1 5) . �4c ra Stater
Phone No. G!N-id3- t➢S� Zip Code: 'i gYLI Fax:
E-Mail: Phone No -ice_ W-7q-T)J Z
1
Fill in fee simple Title Holder on next page ( if different E-Mail b �,,n e e .n S d %ruN Cc . c6'rl
from the Owner listed above) State or County License /R el / 3366 r7
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.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 o Lessee/Contractor as Agent for Owner
Signature of ntractor/License Holder
70er/
STATE OFRIDA
STATE OF FLORIDA
COUNTY OF 1 v
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of�f120& by
h.e �.
this_�__ gday�of�� 20� by
C. &C � ._Y
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
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(i iat re of Notary Public- ttate of Florida)
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