HomeMy WebLinkAboutBUILDING PERMIT APPLICATION5
All APPLICABLE INFOO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l (�' zri� Permit Number:0C0`�1,4
SCANNED
BY
s St. Lucie County REcEMD
- Building Permit Application OCT 2-9 203
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucle County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
PROPOSED 4MPROUEMENT LOCAL ION':
Address:. I S 2 Nw SL #6�
Property Tax ID #: q t(uo — ?0 3 — 6 _ooD- 6 Lot No.
Site Plan Name: Block No.
Project Name:
D T IlE'D DESCRIPTION OF WORK:
(�"tp�c SELo ae/ wo�l�r Sllowe F/odti Ovr7--ov/
rc kx.,4-e flaw;!j ... te tolow f-
CONSTRUCTION INFORM TION:
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: 1 t 0 Sq. Ft. of First Floor:
Cost of Construction: $ 13 00 `D Utilities: ✓Sewer _ Septic Building Height:
OWNE ESQ
Name Id1A e. 'FeeL\_a
Name: P�
Address: I S 32= -Nw " er.� ct�, C�—
Company: Ise SO'
City: (7a (%k C r State:
Zip Code: O Fax:
Address: 3 Y
City: State: K
Phone No. - -
-
Zip Code: 3454_3 - - Fax:
E-Mail:
Phone No 1•72-• 3 ri'- 9-3
Fill in fee simple Title Holder on next page ( if different
E-Mail ('k L( C.O ^
State or County Licensees 2 9 2 $'9
from the Owner listed above)
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.
MAY, PPLIE MEN MA' L GONIt3STRUCTION LI - tAW
NF
MA ION:
DESIGNER/ENGINEER: Not Applicable
Name:-4-t0--.,A C
MORTGAGE COMPANY:
Name:
JLlot Applicable
Address: rf Y tzic. pt L D
Address:
City: P0,2AC�1-tICA9 State: r-1-
Zip: -Cysr7 Phone 1)2.3sc_};as
City:
Zip_ Phone:
State:
FEE SIMPLE TITLE HOLDER: LeNot Applicable
Name:
BONDING COMPANY:
Name:
of 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDnj l
OF ORIDA 5
COUNTY OF I— ` �� p--ice
COUNTY OFSTATE
The forgoing instrument was acknowledged l2efore me
this, �ay((o��f -PS—e� 20
The forgoing instrument was acknowledged efore me
this 20�y
, y
0 <
:!2,9aybf ,c7,
'—�
Name of pers n making statement.
ame of person making statement.
Personally Known OR Produced Identification
Personally Known . OR Produced Identificati n
Type of Identification
Produced �(� Z
Type of Identificatiory�
Produced T L
(Signature of Notary P I` a, df F oe -
��+=State
(Signature
f N t Publicg tam
°��
of Flbr�ida No ari p
�a Cbm0'galbn Public
=State of Florida -No ary Public -
'?
Commission No. # GG 270
Commissi
Commission # GG $EFrA);3
Iv1Y CommissionExpires9
October 22.
'»`.9,;,;;°:`P ommission Expires
October 22, 2022
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