HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:' a SCANNED Permit Number:
BY
St. Lucie County
COUNTY
c
Building Permit Application%> `lig
Planning and Development Services SC
Building and Code Regulation Division ""1/0 'goP.od
2300 Virginia Avenue, Fort Pierce FL 34982 �C°o���i�,'r
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ,
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #3.403-502-0296-130-8 Lot No.
Site Plan Name: Block No.
Project Name: Sri a fi ^ s
DETAILED DESCRIPTION OF WORK:
c_t-, al LQrnihti.m Screcn C>6U` ;nL165L.eYes
6V x 3n 5 $" by
INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing —Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 01,
Sq. Ft. of First Floor.
Utilities: _Sewer _Septic
-Windows/Doors
-Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRA(ffOR:
Name U)"A[Y
Name: f S61 3. �uJrrGn
Address: (?S[o I4 c5ci 51''.
Company: � onee,--'>creen Co .tiyL,
City: br:a ice) if re-c, State: r1—
Zip Code:Fax:
Phone No. 8 `) Q . -1 `I 5 .7,
Address: I I oS,2 Zi %Aa mop C
City: 5 . L, State:L
Zip Code: ta" cry Fax: ` ACA-ta_i,
Phone No 3A b. 43(9
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail4�iic>ys eery%er-r
State or County License ,)CV\ D to rp R t q
,li.-/V V V, ,nu,e, a ncuunuci, nonce or commencement is required.
If value of HVAC is $7,500 or more, a RECORDEDNotice of Commencement is required.
i r-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:_ -IDn Kmk+Aaenc.
MORTGAGE COMPANY: Not Applicable
Name:
Address:Po Sox 1o039
Address:
City: RmvA State: FL
Zip:_33614 Phone t3 ,15-9 59
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 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 Court ty 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 ano 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 l will, In all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fallowing 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 COMMENCEME MUST BE RECORDED AND
POSTED ON THE JOB SiTE BEFORE THE FIRST INSPECTION. IF U INTEND T BTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOY NOTI OF MENCEMENT."
�-
Signature of Owner/ s e/Contractor at Agent for Owner Signa ure of Coo tact r/License Holder
STATE OF FLOR //�� STATE OF
COUNTYOF r.LIAhI� COUNTYOF FLORIDA..
The Moing inst men was a knowledge efore me The forgoing instrument as acknowledged before me
thi day of Q, fY1�DX. 20�by this "�Q day of S Lr Oe✓ 20 A by
iiA, If- n
Name of person aking statement. Name of person making statement.
Personally Known OR Produced Identification V0, Personally Known k/OR Produced Identification
Type of Ident' catie Type of Identificati
Produced it V � � I nQ Produced .•kVa; , _
t1' S WALLACE
^ 'c My COMMISSION # GG023777
(Signatur Notary Publit=5t
�
II //�n/
Commission No. 7�7
taryPublic - State ofFl
.a Commission if GG 2496
°rn.,.' omm. Expires t6,
` OF °° jSgal; pAugission
Bonded through National Nota
tureofNotary u c-
No. i� 6 � r1
� (Seal)
4Assn.
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
lO
DATE
COMPLETED
ev.