HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIlAPPLICABLE INFO MUSE COMP�c i rD FOR APPLICATION T BE TO BE ACCEPTED
Date: J IO. SCANNED Permit Numl
BY
f� = St. Lucie C:,ayijty
Building Permit Ap
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Property Tax ID
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK-
Cous�
L CONSTRUCTION INFORMATION: -
Additional work to be performed under this permit- check all that apply:
, echanical _Gas Tank _Gas Piping _Shutters _. i IndowS/Doors
o�Electric Plumbing _ Sprinklers _ Generator ?Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 3L% (o
Cost of Construction:$ 3S Q.000 Utilities: _Sewer I Septic Building Height: C%
OWNER/LESSEE:
CONTRACTOR:
Name_C--S-x AM lo et2 R2 . e-
Name:,bj IA
AelLai
Address:taa,(a 56 nDAm46It, AD-
Company: Lk V'Sie_g'S TPC
City: :125 L_ State: _
Zip Code:3Z/ qr6 3 Fax:
PhoneNo.77a-
Address: /,& 5S 3kA 'PI s W
City: V e leo lea o 1^ State: �)
Zip Code: 3a96SS Fax:
Phone W 77,�- not— '31t
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
�t
E-MailPhIA 114 un'+5 dL 'e0 {Del ISoce l h r !Jd
State or County License 4 LC- /Z% 710
R value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER:
Name�� ruc=�_riF,�sil��s/�I,.
_ Not Applicable
6�eo..p
MORTGAGE 5OMPA Y: _
Name: C�wtep 5 e
Not Applicable
Address--4 S�1
Address: tL w 13)o
City: -Ilraeti
Zip:3gCf'b1 Phone 7
State: IGI
-L465-
City:'95L-
Zip: 349$b Phone:_9Y07-1f6oa
Stater_
FEE SIMPLE TITLE HOLDER:
Name:
_ of Applicable
BONDING COMPANY: _Not
Name:
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."
Sig at of Own r/ Lessee/Contractor as ent for Owner
Signat a of Cont ctor/Lic nse Holder
STATE OF FLORIDA C\
��
STATE OF FLORIDAC1
COUNTYOF� J�C
COUNTYOF ��t •�
The forgoing instrum nt was acknowledged before me
LO 0 �r
The forgoing instrumej�t\\waas-s acknowledged before me
d
this day of 20 19 by
this 10 day of CT e— . 26_!n by
Name of person making statement.
Name of person making statement.
Personally Known I� O cludiffiMnSillititift
Personally Known u OR Produced Identification
Type of Identification NOTARY PUBLIC
Type of Identification L111an S. Shep?iiiW—
Produced_ STATE OF FLORIDADA
Produced AND%OTARY PUBLIC
Cammli FF93190MI909
STATE OF FLORIDA
Expires 12114/2019
Carmtf FF931909
Expires 12/14/2019
(Sigriature of NotaryRublic- StateofFlorida j
• na re of Notaryry Public- atee of Florida )
Commission No. `r 15� `
J19 0
(Seal)
Commission No.�1l� L (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19