HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED '
Date: �•�1�• %� Permit Number:
4unoo a)onj -IS
43NNHOS
Building Permit Ap
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 X—
PERMITTYPE:
I,CU&C', 01iu,55
a
• 0 6to.
PROPOSED IMPROVEMENT LOCATION= I
Address:
Property Tax ID #: NSOa,- 503 d0Ur7.-000-
Site Plan Name:
Project Name:
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing I ! =Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction: $ /AJ 850
Sq. Ft. of First Floor:
L
Lot No.
Block No.
Windows/Doors
1 Roof e Pitch
Utilities: _Sewer _Septic Building Height:
a
OW(VER%LESSEE ;'
CONTRACTOR p w.,
wlv
Name e—
Name: L Ki (fC i
•Address:: fto... l�G 1tR(i. f�. �)Y1ii i5 �
Company: _.;
"City: _,?.Y15eY1` �J'Z74c1 i < State:
€L6w�at,
Address 39 N B ER•ROQD
Zip Code:.3Ng15`7 r Fax:
City. °' ST A Fl- State:_
Phorie1Nb--'d\q$- 33b:=.�g5(o4
Zip Code: Fax: 77R-331{- 107A
Phone Noggq 33q-toil
E-Mail-3Oe-ht.arD(b(c�4&Jym,com
Fill in fee simple Title Holder on next page ( if different
E-Mail' A WW.AvrejkloW, V1�+
State or County License
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 $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN7AL�GONSTRl1CTJON LIEN:LAIN INFORMATION`$''
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
_
Name:
_
.Name:
Address:
Address:
City:
State:
Cityi: •=l-
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 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
"WARRING 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
w.Tu vnnn i ctunco no AN Arrnotuov nFcnmE DcrnDnwr. Ynim NnTICE OF COMMENCEMENT."
Signatu of OI net/ Lessee/Contractor as Agent for Owner
Sigrlltre of ontractor/License Holder
STATE I ORIDA�� LL /I ,
STATE OF FLORIDA I e.
COUNTY OF '�,
COUNTY OF L_lJ
The forgoing mstru ent was acknowledged before me
this � day of ru 20� by
The for oing instrument was acknowledged before me
this J day of rU-Q'm 20a by
�IUU1e�' V1/l l I I GI
Iyyl I I GI
Name of person 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
A n
u(�
, Publa; State of Florio.
to ��qq�ryry
tDanrfa Jayne Hall
(Signature o+Nob'P7!�
Signature of No Pu lic- S
y,� �lMyCoimm�st0n GG 2076l6
Commission.9'„ 'I�tSFB1)Wnb2o22
M'r � Notary Pue6c State of Florida
ommissionNo. 0585 !4 Dppna�ayneHall
fii{irnisawn GG 207535
EI nea 04115r2022
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DATE
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COMPLETED
Kev. L///ly