HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAD APPLICABLE INFO MusT BE cOMPLEfED FOR APPLICATION TO BE ACCEPTED
Date:. ��-`�� SCANNED Permit Number:
_ BY
St. Lucie County
_ *"0 Building Permit Application RECEIVED
➢lanning'oridDeveiopmenr5ervices NOV 19 70,19
Buifdiny:gnd Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 349R2 ST. I u ie Co y, Permitting
Phone:,(772)462-1553 Fax:(772)462-1578 Cori mercial Resl - . _
PERMIT TYPE:
Address: FOi2T PIERCE FL34946 �-
5039 AMY'LANE -
PropertyTaxlDY —tJ(�"LotNo._
Site Plan Name: _ _ _ Block No:
Project Name:
' I d a
�
v
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
TotalSq,,Ft ofConstructiori: Sq. Ft. of First Floor.
CostofConstruction:$ -.-I1500,�- Utilities: _Sewer _Septic Building Height:
Name AN
Address /i d. �r
Company: 3 G e 1t t
C;; Stater
Address: Ala to �,.1 W7u✓c tLNe
city, S, lvu State: F
27p code: Fax: CfS�� 7y`f �$37
phone No.iL & ' 7r/�/$
Zip Code- - 34g 5 S Fax:
E-Mail:CcK'cJSCAQ� Crn�
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail �Uv✓t` lc }n c @ Vtia ca h
State or:County license
from the Owner listed above)
if value of construct on is $2560 or More, a RECORDED Nallw f Commencement is required.
if value of HVAC is $7,M or mare, a RECORDED Notice of Commencement is required.
,
I
1
DESIGNER/ENG.INEER:
Name
---Not Applicable
MORTGAGE COMPANY:
Name:
_Not Applicable
Address: _
_.
Address:
City: --
Zip: Phone =
State:
City:
Zip: Phon `
State:
FEE SIMPLE TITLE HOL _ :
Name:
_ Not Applicable
BONDING' E ANY:
Name:
Not Applicable
Address:
Ad s:
City:
r.
Zip: Phones
iP: Phone:
07WNER/ GONTRACfOR AFFIDVIT: Application is hereby made to obtain apermit to do theworkand installation.as indicated.
bcertify that no work or installation has commenced prior to the issuance of a permit
In consideration of the granting of thisrequested permit, I do hereby agree that 1 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 ctncurrency review: room additions,
accessory structure;, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
TO OWNEW YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENTMAY RESULT IN YOUR PAYING
FOR IMPROYE1f afTS TO YOUR PROPERTY, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
D ON THE JOB SITE BEFORE THE FIRST WSpECTION.,IF YOU INTEND TO OBTAIN FINANCING, CONSULT
OUR LENDER OR AN JMORNEY BEFORE RECORDING YOUR NOTICE OF CONIMCEIIIENT."
If n ontractor as Agent for Owner Signature of Contractor/Li ense Holder
OFO(�jaunl & STATE FLORIDA
- -
COUNTY OF
The for ng inst n acknowledge before me
this dayof'pQa 20 by
,�Srn_ QY1�S�h�k.
Na ofperson making statement.
Personally Known OR Produced Identification
REVIEWS
of
No. 1 44�� NATAII6ed IAANGLES
NotaryPuhlic - State of Florida
o. &Oi Commission N GG 700795
Pum Jorge Pacheco
Notary Public
The forgoing instrument was acknowledged before me
this i4 day of 20Lq by
Name of person making statement.
Personally Known OR Produced Identification /
Type of Identification pt-
Produced
(Signature of Notary Public- State f Flor' a "-
Commission'No. .✓r'�`'•, NATALI NGLES
1 Notary Public-Stateof Florida
Commission t GG 700795
PLANS
REVIEW
Commission No. GG 254755