HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: SCANNED Permit Number: `IIO' 01, /
BY
St. Lucie County RECflVEO
LWIS Orrn��
- —� — Building Permit Application PQS,tnnyo -oiy
Planning and Development Services vqe eountyent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial `Residential
PERMITTYPE: CO tVvAtiercr'� S
PROPOSED IMPROVEMENT LOCATION:
,
Address: 3/00 /V #WS Ali} l--Df I r'eece Pr 3 %c&9
Property Tax ID
Site Plan Name: SAnIoQS on, 7"{tp e;(-e4, Block No.
Project Name: S/aNr{s �, �. %rA e cc e1qti
Additional work to be performed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_Electric -Alumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
. a O
Cost of Construction: $ 7 It 3 yS Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t (Pre-511d
Name: C
1
Address: 3/0O /die✓c-c
Company: CfL4.5f 41 &JS
City: Ao / t P; r e c e State: C- ..
sip_Code—�) �%�/ _Eax: ___ —_City—VPfo-1>
Address: �-Df� v
Zip Code: 32-96 7 Fax:
_Phone No 7 -5-6 - 3,ob7
E-Mail heA ov C to Crux A4I Poeds ilrc . CL7,
State or County License ?C 1 `f.4;-7 IXO
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction Is 52500 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.
SUPPLEMENTALCONSTRUCTION LIEN LAW
INFORMATION
DESIGNER/ENGINEER:
Name: MRV —n/ .Alf ee
_ Not Applicable
iI/✓
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 14s35 2 o r`
f,re F
Address:
City: l p r 13eA-C L—
Zip: 329 Lo Phone 7 7 2 -
State: FI,
565- ob35
City: State:
Zip: 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 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LJENDER OR Apf ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMME MENT."
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P
Sig ature of Owner/ Lessee/Contractor as Agent for Owner
Signatupffof Contractor/License Holder
STATE OF FLORIDA /
� ✓ `
STATE OF FLORIDA /Q
COUNTY OF h f �`
COUNTY OF —� ' U ``'
The forgoing instrument vlas acknowledged before me
The forgoing instrument yyas acknowledged before me
this trday of I7GT- 20_Lqby
this2 day of (�ci 20 /2by
—
M,ke
T
s
IUI LI^ynJAo?e
f;2cr(,_, Z)?,,/
Name of person making statement.
Name of person making s ement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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A4 ' y
�n
(Signatu a of Nota ''i.tt state of F&1 AILLlB
(Signat a
Commission No �i C W4.2=
Co mml pn .., My ,1IBSI0NtC�ti331 e
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