HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr ,l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4•Z• 16)• SCANNED Permit Nui
BY
" 'J �= 2 R—M St. Lucie County
Im Building Permit Appl
Planning and Development services
Building and lode Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
ation APR 2 2919
Permitting Departmen
St. Lucie County, FL
PERMITTYPE:
PROPOSED
Address 5/O1 Al jfWv 6 /H Far!- P1ercc , FL-5LIgVg
Property Tax ID #: j y / O -,SO Z" DODO" 000 -3 Lot No.
Site Plan Name: OCMA 9e_(of7'S ('0 0F, /Ill (Deck/ Cam m�.cf /ey�'r Black No.
ProjectName:�Qr
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GOjVSTRUOTtON INFORIUJATION r
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ IS_ dmk Utilities: _Sewer _Septic
Windows/Doors
_ Roof Pitch
Building Height:
01NNRjI ESE , , fi 3 xQH7AAT(?R
<x ? 7 r «:
Name QCearl fern✓is ro'010' (A G
Name:
UAI (9 a. L(,c
Address 510 / M#IA /f'Jh ",!4 At r9
Company:
City: IFJ2 _ PI0-fCt- State:,a,
Zip Code: 34gyq Fax:
PhoneNo._ %7a-4(all-6463
Address:_ Nc) Q(j D)(1(/C 1> wy
City: An 6aArk State:_z1
Zip Code: .3Z9&0 Fax:
Phone No '7 )R-S(o7-78W 7%2_g86_'?(cgf
E-Mail:O(_eGtt(esorjrivtcrvtae/acrM¢ I. c&J41
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail Jfew 6 cW laR - eorW-}Titian . co/A
State or County License CC�C ISP. S $3(a
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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SUPPLI^MENTALCOfdSTRUCT'10N�LIEN LAW INFOR_MATJ_ON�,�
�",�` � '� �y � "_, �' N`'_�
DESIGNER/ENGINEER: Not Applicable
Name:7eci^ h
MORTGAGE COMPANY:
Name:
/—Not Applicable
Address: w fw
Address:
_
City: sel; r g �. State,
Zip: &n�Phone
City:
Zip: Phone:
State: _
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
Not Applicable
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. 11
St. Lucie Count makes no representation that Is granting a permit will authorize thedpermit holder to build the subject structure
which is In con ict with any applicable Home Owners Assoc ation rules, bylaws or an 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, 1 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 IMPROYEMENTS 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
tearuaN
STATE OF FLORGID� i '�1� STATE OF FLORIDA n
COUNTY OF 1l� COUNTY OF /hdiQYl ICiVEf
TheIfooing instr t w acknowledg,ed�b
efore me The forgoing instrumentwas acknowledged before me
thisdayof 20by this�dayof April .20� by
i(1(n )m g6herll- A . Dahl19P M
Name of person makinnggjtatement. Name of person making statement.
Personally Known V OR Produced Identification _ Personally Known 1'� OR Produced Identification
Type of Identification Type of Identification
Produced ' n Produced c
WA
(Signature of Notary Publ f&iffi aB Public - State of Floridi Ignature of Notary Public- State of Florida )
' + P Commission # GG 270518 _a4p ;Pbe� IAURIEACHADWELL
Commission No 6 oa% -- ''+ Myer V. Expires Oct 23, 202 mmission No�:3 qF 9 ,(5680jm(sskn # GG3099A!
aphas March 10, 2023
REVIEWS I COUONTER I ROE I W I SUPERVISOR REVIEW I REV EW I VRE EWON I S REVIEW E I M EVIEWVE