HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (j Date: Permit Number: lOtDc��
SCABD E
RECEIVED
NUMBER- St. Lucie
Building F8iffi- it Application OCT 28?919
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID t#:
Site Plan Name:
ca
Lot No. 93
Block No. 2
>. - Ill- i � "i7.' �liLs�G7�!S
Additional work to be performed under this permit - check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shuttersi Windows/Doors
Electric _Plumbing _Sprinklers
Total Sq- Ft of Construction: 'tom b
Generator _ Roof
Sq. Ft. of First Floor:
Cost of Construction:$. 4442/3~/. toff Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name Col-e-VA MAic-D..%,AAI
Name: Sup�Ibr SI�F Sr �r�c
Address:I aUI CvCdA(A+ 01,e , Mor44n
Company: (el Lo r 5[is f {wv l
City: ? 5 L State: f
Zip Code: ?W9 5 Z Fax:
Phone No. '�%Z- -2-6 7^ DSZ,B
Address:
City:' ^' -^ -: f G State: 1�L
Zip Code; 3-24PA*3 3Z9
Phone No-T72.Y60-c(lo��
E-Mail: r�p!)bo�r c� 1dQF'a(�g.mr4:1. 0-Or"
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License M �7- it 3
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.
T
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
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 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 concurrer cy review: roomadditions,
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 OWAN ATTORNEY BEFORF)RECORDINGYOUR NOTICE OF COMMENCEMENT." .
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
—i
STATE OF FLORIDA ) `)
STATE OF FLORIDA
COUNTY OF :
COUNTY OF
(r
The forgoing instru ent was acknowledge;L,eefore me
The forgoing instrument was acknowledged before me
thi �%dayof yy�__ 20f�` by
LXLCD hll.. ' ' L"D A
this_dayof 20_by
Name of person making statement.
Name of person making statement.
\
Personally Known OR Produced Identification
Personally Known DR Produced Identification
Type of Identification
Type of Identification - ...,. .
Produced p_ `�•—_�--�}��
�C1V V(�II_�1X �F' KIAY�Q t(l�
Produced
ign ture of Notary Public-.Mto of Florida j
(Signature of Notary Public; State of Florida)
Commission No.l,•vp4—
Commission No. (Seal) '
s: LASHAHNA INGRAM•RAHMING
5 .MY COMMISSION N GG 275060
_
IRES: December
M,2022
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Rev.2/7/19