HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ld`q \1 Permit Number:
SCANNED SCANNED
w ry��r BY BY
■ St. Lucie Coi,r,' St Lucie Co RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578
unty
Building Permit Applicatio OCT 0Coun9 LST.iq,o
iqcle ty, Permitting
Commercial Residential
PERMIT TYPE: re-nC! &
-PROPOSED IMPROVEMENT LOC
ION:
McLS
f 10 e "
Address:_/,24- AJ L4S O/0.5 An'U-E
Property Tax ID#: 45-11-5-00"o0,94-pCC 9 Lot No.
Site Plan Name: 6 eo-cif"i�O""U S e 6 CCa /4 LJ--� Block No.
Project Name: A ea-c-h fkLLS 6- 617 G a 4 r L C
•CONSTRUCTION INF.ORMATION'i
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:
Cost of Construction: $ a `)<
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE -- ',a q. '_ -,
r.�1
wCONTRACTO,R: Y
Name?'IPAMgou5e AO-c'
o14"r�
-"-a-
Name: C>�e5t�/f�iC�r>[07t0(
Address: /09`JT/ 5 00coun,bl"l✓e- 1-nf7a-
Company:.54uOr'/ F- I Zr),i PQLl U
City: J W,S en heaLCJ-) State: FC,
Zip Code: ?4 T5 1 Fax:
Phone No. S 401-3.7 3 - %'7170
Address: PQ 60K o7-&J6
City: 54-uar f- J State: FL
Zip Code: �*49 ] Fax: 77ol-o2iF--70-7 -
Phone No 77a—ad98— It 51
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail CL/ op -
State or County License aDCM
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.
i
SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ✓Not Applicable
BONDING COMPANY: i Aot Applicable
Name:
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 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 EN OR A ATTORNEY BEFORE RECORDING YOUR NOTICE COMMENCE ENT."
�24
Signatur wner/ Lessee/Co Tractor as Agent for Owner Signatur ntrac or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF /lMGUc iNL- COUNTYOFM4-r4in
The forgoing t was acknowledged before me The forgoing instr en was acknowledged before me
this _ day of OV� 6 e1� 2015 by this _ day of u 2Y 2019 by
/Sl(a hkzl 7t GL. Q",iA!- �IG%ZYiD ilG�
Name of person ma ing statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary (Signature of Notary P ' -
,yti Notary Public Slue o1 Florida .y't Notary Pu lic Site or FbriCa
Commission No. ? Diane Wm§I@�.� Commission No. f Diane K V
al
emy xxplrea 1212812022 2a6707 a MY Go ion 00 286701
�Expire 1 812022
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