HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l o ) "/. SCANNED Permit Number:
•
St. Lucie County 4U@UJ4-jPdaq 5,ii-pi i
-�� Building Permit Applicati n s)oZ note
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Res!
PERMITTYPE: S-/T- 3GitGi �fF�Q
PROPOSED IMPROVEMENT LOCATION:,
Address: 1.295 94,7 • ,v 121 Qo®p , fo-QT p/,E Ac1E
Property Tax ID #: 2 3 t 3. /2 y— Doa 1- Ooo -S Lot No.
Site Plan Name: Block No.
Project Name: CO/V�4NT S1IC.�
DETAILED. DESCRIPTION OF WORK:
,altlt.D A o/FICU hlOoj� 94.0nt&A, SHF/S *Af epNe2Erff�
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator X Roof =/j. Pitch
Total Sq. Ft of Construction: 25Z Sq. Ft. of First Floor:
Cost of Construction: $ 02 Z-% 91 ego/ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name L1.crrYyAol GoniAi✓Y
Name:
Company:
Address: 13c->,/�!€7T .Pn/�d
City: 'AwcC* State: FL
Zip Code: �tlq tf 7 Fax:
Phone No. 77.2 -2 6o — 9 9 S' �/
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: AP/»he /'p..0Y'z-/a w ucAsAge-f
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN R/ENGINEER:
Name:IV- ,� Jga2&F-2
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address IR r0 �' ^
Address:
City: r ✓oo AiTR/L
Zip: Phone_?Zs-;?2f
State-:, f
-41Zip:
City: State:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 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 SIRE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Z�2 9��
ig " t0-' ner/ Lessee/Contr or as Agent for Owner
Signature ofContractor/License Holder
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instr ent yvas acknowledg d before me
J
The forgoing instrument was acknowledged before me
this day of . 20A by
this _ day of . 20_ by
PN1441)fi4y Pow n&ft
Name of persod making statement.
Name of person making statement.
/
✓
Personally own OR Produced Identification
Personally Known OR Produced Identification
Type of I enti ion
Type of Identification
Produced
Produced
]
lS6/'
(Signature ggato of t nrida l
(Signature of Notary Public- State of Florida )
rs-•••::• AUDREYB.HUMPHREY
Commission
SION8917
Commission No. (Seal)
`;� as EXPIRES: March6,2023
Z.. OF h
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Iry
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Rev. 2/7/19