HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE I
Date: '0 11 _ ( % ri S
_LTED FOR APPLICATION TO BE ACCEPTED
PermitNumber:
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St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applicati � 4,° V,
Commercial Residential_ :14
PERMITTVPE: cyL_
,IL, n-ham
PROPOSED IMPROVEMENT LOCATION:
Address: %S/& a ke_o� Sit & 4 - ) Y 2_� 4-
Property Tax ID#: na.3./n - .50� -6C�O% -( 0D0 Lot No. 066-
Site Plan Name: rAt- m /3 E Z 6 Block No.
Project Name: /Y10 2 n r . nr C� S , cLz_. PI-1-R SF / / A
DETAILED DESCRIPTION OF WORK.
C�
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 6//Z Pitch
Total Sq. Ft of Construction: a 7A/L/ y �B Sq. Ft. of First Floor- 1617
Cost of Construction: $ / q i � 2qt Utilities: ✓Sewer _ _ aeptic Building Height: ,2 7
ODUNIER/9 ES$EEe
CQNTRACTR:
Name_
LL
Name: (rleA(lie.vN 1)41I
Lompany: R.)IrleY5 Ll_C-/
pI
Address:J71,', •. !
City: k n a ?e State: FL
Zip Code:'�9'/6 Fax: 77.2,l q k
Phone No. 17) . i eid • ' Fal)
Address:37a S 5 FA,,4 (Y'0/l Y? SlVA �; k_ lu
City:.E (Hi it 4 - State: FL_
Zip Code:k429 6 Fax: '17.1- Q � c7iS:ti
Phone No `/7J
E-Mail:
Fill In fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail �i-!n JD.I i rut ( f)ty riAYl1 J,S (,',I
State or County License C130
.. VQ UC V {.URBU ULLAUl1 lb q&9U I ur nwfe, a newRUCU 11UMU ui wnmoe,ocemena,s required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
���PLEM�NT�1(CON�'fRu�S%��: rl�lf�r yr�
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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
BONDING COMPANY: _Not Applicable
Name:
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 authorise the permit holder to build the subject structure
which is in conflict with an yi applicable Home Owners Association rules, bylaws
or and covenants that may restrict or prohibit such
structure. Please consult w th 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."
Id 2"
Signature o Owner/ Lessee/Contractor as Agent for Owner S nature of Contractor/License Holder
STATE OF LORIDA STATE OF FLORIDA
COUNTY O S-k Luc_t e— COUNTY OF Si 1 rJCi 2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowleci ftbefore me
this (o day of 20 lE by this j_L day of 20,U by
ame o erson making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known (—OR Produced Identification
Type of Identification Type of Identification
Produced Produced
11
K 071c<a �dZg� dYta� U c •TeB4 RHONDASROWE
(Signature Publ(c-State of.Floritja) Commission # �G 10a 56Slgnatdre of Notary Publio f*Flon a �,�'1"
• N : x res May 19, 2021
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