HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTE'rr "'
1
Date: !`_ 7 -/ D% Permit Number: 4 rAsl
SCANNEDBYRECEIVEb
. St. Lucie Co
Building PermyPApplicatio Nov 0 7 2019
Planning and Development Services ST. Lucie County, permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential L
PERMIT TYPE:57� TD/Z
0 D M O O
Address: �J?i 1) S GO(2TFZ %/,VO FOIZ P/ E1t(fE rL ;I
Property Tax ID #: Lot No.
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Site Plan Name: : l VV\Y U n N EL L Block No.
Project Name: ::fj CA p U 2 P CLL_
pC P O OF O
o577gav/J-17,,Y CIJWi5�r7-r9-tat
CONS t1 i0 F RMATIO .
Additional work to be performed under this permit -check all that apply:
_Mechanical --GasTank _Gas Piping _Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: A11A Sq. Ft. of First Floor:
Cost of Construction: $ �0i 0 9 7 Utilities: ewer _ Septic Building Height:
1NN E
•O OR.
Name cTlN-, PV RNE'C-C
Name: 60Y 5, / i oy a-G
Address: '3-3D5 C®lZTFZ 1334.11.0
Company: G. S, /-KbVaF,.6(-cCT2.)c
City: D/_�T /!C>? State: tL
AddressZ/8"=DST%1/L$02 1ul�tUG
city*: State:�L
Zip Code:. �Cig�l�i�,. Fax N�f`l
Phaneaallo. rsr77Z .'Zi).g fJ5.3.;?
ZidCode.-- .3Z964- Fax:
E-Mail. �. -:Ni /i _. v.=- .T _
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Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail (Jr (S SN lO CnM CA5T, IV JE-T
State or County License 5C/3 01) 6/ ZZ
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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: - State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable I BONDING COMPANY: Not Applicable
Address:
City:
Zip: Phone:
Address:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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."
O", Ak J
D"fiW Jl . 7n,6�
Signature of Owner/ ssee/Contractor as Agent for Owner
Signature of'Con actor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA .-
COUNTY OF �'rt_/-�� . nl/o-�
` �_ —, �
COUNTY OF �iL �iV�P�t
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The for of g instrument as acknowledged efore me
The forgQng instrumen as acknowledged efore me
by
this ay of A. 20�by
this r day of 20
OuV 5, m aa2u
GvY 5• m oo/m
Name of person making statement.
Name of person making statement.
Personally Known i✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
///
////IiLGLHu-t�C_ _a��
(Signature of Notary Public- ate of Florida)
(Signature of Notary Public- tate of Florida )
Commission No. _.•.:n�^""•., WI URGEON
My COMMISSION#GG136489
Commission No. ILLIAMSU
EXPIRES: August2B,2021
MY COMMISSION # GG 136489
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REVIEWS
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SUPERVISOR
PLANS
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REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19