HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO1 ', p' ETED FOR APPLICATION TO BE ACCEPTEu
Date:
SCANNED
BY
St. Lucie Count
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
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Building Permit Application a a3
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Commercial +-- Residential
PERMIT TYPE:
;PROPOSED IMPROVEMENT LQCAT)ON
Address: :RSO M 02;7T[i 9004 P&
Property Tax ID #: 013 1 1- IZ3, 00D i - 000/6
Site Plan Name:
Project Name:
L_E;D
Additional work to be performed under this permit- check all that apply:
_Mechanical
Electric
_ Gas Tank
_ Plumbing
_ Gas Piping
_ Sprinklers
—Shutters
_ Generator
Total Sq. Ft of Construction: _ Sq. Ft. of First Floor: _
oa
Cost of Construction:$ 9L0 2at4 Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
r OWNER%LESSEE
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•CONTRACTOR ;
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Name
-GNOW
Name:I�e.nneT A. C-r-PLrmrr1 S2
Address: 1 O t i,5
3W TYLf✓� CST
Company:
City: IP5L
Zip Code:3 49
PhoneNo.
State:_
Fax:
Address:56D MA)5A1rF 9R-1(i-r 'DI —
City: PS L_ State: F-L-
Zip CodeM Fax:772-3c/0-9/7-r
Phone No 772-340-7 y 74
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail oAL4RAknA (3 64461 e--c � c 0"
State or County License CC 13 00 3 y / S
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.
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Not Applicable MORTGAGE COMPANY:
Name
City: State:
Zip: Phone
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: I 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
F kE?4 I L
Signature of Owner/ Lessee/Contra for as Agent fo, Owner
Signature ofA
ontractor/License H Id
STATE OF FLOn_4
STATE OF ORIpP�
J� P,
COUNTY OF l.�Cl
, _
COUNTY OF Sl LULG
The f r oing instru ent was acknowledged before me
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The for oing instrument was acknowledged before me
this dayof �20ia by
this ayof M, AC8 20ft by
KU411" A. Omwev e sv,
KMn6M A_r�wci W,.
Name of person making statement.
Name of person making statement.
Personally Known O
onally Known lr OR Produced Identification
Type of Identification �;;o�•.PAM,WASCOM
T e of Identification
Produced '`� MYCOMMISSION#GG 1321
1Pr uced ,.•�,"p;:':;"••,, PAM WASCOM
MY COMMISSION#GG13216
EXPIRES: August12,2021
Bonded 7lw Nate y Public Undorvn
'�. ,,
tero yi �Pr EXPIRES- August 12, 2021
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•,R,,,•• BondodlMuNoLvyPubllcUndenml
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.