HomeMy WebLinkAboutBUILDING PERMIT APPLICATION:OMPLETED FOR APPLICATION TO BE ACCEPTED ht��
1J� Permit Number: ' 0 Q
� ` C 0�-C— 7 RECEIVED
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Addresw
Property Tax ID
Site Plan Name:
Project Name: I- i IQ L Oi if
U�AJ OCT 14 2019
Building Permit Applicatio
SCANNED T. Lucie County, Permitting
g BY
Commercial t. Lucie COURWsidential _
Lot No.
Block No.
s ;
CONSTRUCTION' INFORMATION: ` ''` f'
Additional work to be performed under this permit —check all that apply:
Mechanical _Gas Tank K Gas Piping _Shutters windows/Doors
Electric( Plumbing _ Sr' e prs _ Generator _7X_ Roof /v Pitch
Total Sq. Ft of Construction: Y�- f s Sq. Ft. of First Floor: _ 4t 7i 9 3 I
Cost of Construction: $ 3�3, / t%1D Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:'`
GONTRAC70Rt41
Name B
Y-41-&e
Name: O 0kY
Address: 7l'o-7/ rolW l�e4 P4 '
Company: n A J (r 660I JEw M,,P ,-ekC,
City:�Aellcr Stater
Zip Code: Fax:
Phone No. 9/ D i Z (n
Address: 7rJUID410
n
City: Stater
Zip Code: Uqs5l Fax:
Phone No 77- Zl � "'I
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 0 J k P (%l4 UC(0O(d p-- ti(S
State or County License 06 1 -15N f9
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.
-
SUPPLEMENTAL CONSTRUCTION I IEN LAW INFORMATCON:
UESIGNER/ENGINEER: _ NOt Applicable MORTGAGE COMPANY: Not Applicable
Name: `1—c D . .nt' r— Name: fA �ic4biwe l''s1e_Ov iv'
Address: li 3.Nofaa Q,uPn Aluo Sir /3o Address: 300* 3 /-loluda 40p,
City: 1 v tycL State: [= / City: L— 0AP_ kA a d State: •' 1
Zip: ,3z9 i(�) Phone7-7z Zip: 33903, Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
WE
Not Applicable
BONDING COMPANY:
Address:
Zip: Phone:
_Not Applicable
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 IMP}Q YEMENTS TO YOUR PROPERTY. A NOTICE OF COMMJ� NCEMENT MUST BE RECORDED AND
POSTED ON T41E AOB SITE BEFORE THE FIRST INSPECTION. IF YOU J4TEND TO OBTAIN FINANCING, CONSULT
WITH YOUR UNDER OR AN ANTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature wner/ Lessee/tractor as Agent for Owner
Signature UContractor/Licensefiolder
STATE OF FLORIDA /
STATE OF FLORIDA
S% /_UCH
COUNTY OF S% CUc"P
COUNTY OF P
The for idra instrumen was acknowledge before me
The forgoing instrumen was acknowledged before me
this day of U - 20 by
this j� day of c 204 by
Name of person making statement.
Name of person making statement.
/
V
Personally Known ✓ OR Produced Identification
Personally Known J/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
,
(Signature of Notary Pu lic- State of Florida)
(Signature o LSEN
Commi iop,iJq„ KARFN S NIELS(��
„ KAREN S.
P"�'': State of Florida -Notary Public
Commission 2� �- # G�@aes4
State of Florida•Notary Public
Y sion
y� M Corn iS2 ZO 2p
_= Commission # GG 207484
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