HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONV
All APPLICABLE INFO MUST BE COMPLETED FOR ARSt%TTjgN50 BE ACCEPTED % 0 ��
Date: 10- I V' / /nBY Permit Number, ��
St. Lucie County
CEIVED
Buildfn
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g Perml t APplic tion OCT 10 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300-VirginiaAvenue,-Fort- Pierce -FL-34982--- -- --- _ _ St. Lucie COUnty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resi entla
PERMITTYPE: �3)11.)
PROPOSED IMPROVEME OCATION: s s'
Property Tax lD#: —�� ��EZ0 0 DDD J Lot No.
Site Plan Name: Block No.
Project Name: 1 % J 4 fi,4 f- L
DETAILED DESCRIPTION OF WORK:`
CONSTRUCTION INFORMATION:
Addiyional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Z_I�ilectric �<'-F_Iumbing _Sprinklers _Generator,
Total Sq. Ft of Construction: O Sq. Ft. of First Floor:
Cost of Construction: $ -2,) _` 1 Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEES",
CONTRACTOR:
Name ICAlt '.SJJQW94
Name: 1n CJ/ lob-
Address:: --- --1 y eP AAA VT5!6 A S"1-
Company,
U 51dp,.'1-W ILC
City: LULi State, Ac
Zip Code: Fax:
Phone No.'%7�P " 1.2d-1
Address: 7 5 9 9G
SI
City: A Plr>✓ State CFI^
Zip Code2P !fl y ti- Fax:
Phone Notf77a—P3 -J�zi
E-Mail: ®'�51fOWf��t'_y yAFFaid_CaM
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail AtdvAfide4lo-166trow
State or County License 44c&_IAPi a cl
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required. ) Q y ,
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required. o /
SUPPLEMENTALCONSTRUGTION LIEN LAW INFORMATION: ,, J
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:. Name:
Addresses Address:
City: State: City: State:
Zip: at--, Phone d�, -Zip:— - -Phone:— - - — -- —
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." I I '
Me
_Signature-of:LontracCor License Fioliie
QS nature-of-Owner/,T`�ssee Cgiitractor's7iKent:for7Owner
STATE OF FLORIDA -
STATE OF FLORID
COUNTY OF
COUNTY OF
The forgoing instru nt w s acknowledged Pefore me
this LOday of , 20 by
The forgoing instru a tp ,was acknowledgdefore me
this day of 2 by
rI SMWOLLI
D31/), �) [A)" u p-e: -
Name of person making statement.
Name of person making statement.
Personally Kno'vq OR Produced Identification-/
Personally Known OR Produced Identification
Type of Identificat
Type of IdenF� if'ceat
Produced 11 PLC i
Produced Aw 011 ,
JShWa
(Signature of b6rany Public: State of:Fl- da) ;
(Signature '
_1j%,.;"••. AUDREYB.HUMPHREY
_ „
Commis n ?'••.
REy�; HUMPH
Commissio
.- : e MY COMMISSION#G$WM)7
Y
COMMISSION#GG 300817t'J°iid:CgP.
-m' '•� EXPIRES: March 6, 2023
Bonded Thin Notaw Pubec Underurit
B No
REVIEW
vdta:q
PERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19