HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
J=1Q1 St. Lucie County RECEIVED
- - Building Permit Application APR 3 0 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
- St. Lucie County
12300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (7,772) 462-1578 Commercial Residential
PERMIT TYPE: &5t46&Alh'Ab Qa,,(Nf �w1 � 1 2rrla
.,
PROPOSED IMPROVEMENT LOCATION:—.,
Address:J500 Sc OM$r+ Df-- APF lSD,Z..
Property Tax ID#: - 4502-%bZ-Ol�oia000-2• Lot No.
Site Plan Name: Block No.
Project Name: 6A W/✓ON
DETAILED DESCRIPTION'OF WORK:'.' .
C•CYD�If � 7�1J rPa1/OU/a-1FC .OAf/$�7/wr �ot1.¢N. C!'2�1�fzL7arC �TI �'l�iyG✓6',fte
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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 =Generator _Roof Pitch
P�_Sprinklers
Total Sq. Ft of Construction:, ! t7p09��'�: Sq. Ft. of first Floor:
Cost of Construction: $ 1/0� Utilities: _Sewer _Septic Building Height:
' OWNERAtS'SEE _'-.
CONTRACTOR ,4
Namek 4rf i't C&W-01i
Name: j&roopr
Address: 5'00 5 OCQg/MQQ f /
" `,2'G/»SQiGL
Company: Pn/o✓4 ionl cGiNd� t 2.S
City: U�Zs e" r he4c_1n State: t!L
Addresss:21 slag �A 'Purim k7e/P.
Zip Code: 3lf95'J Fax:
City: &Dny-iQeiLln/✓ State:_&
Phone No. 7 34- (60 4 - 2 2 $
Zip Code: 773` *2 $. Fax:
E-Mail:1;7i4C(/J3sa
Phone No 10L$76-56-75-
Fill in fee simple Title holder on next page (if different
E-Mail geA.0y4-ACAJ4--a4'i� @ y4AVe • 4axi•
State or County License CGC-
from the Owner listed above)
If value of construction is $2500.or more, aRECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
ti
tSUPPLEIVIENTAL CONSTRUCTION„LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 con lict with any applicable Home Owners Association.rules,.bylaws or and covenants that may restrictor prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In considerationof 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 RECOR13 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 INSPEcirlak. IF you INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDIN YO .N E OF+COMMENCEMENT r
a
Signature of Owner/Lessee/Contractor as Agent for Owner
Si nature of ontracto Lice a Holder
STATE OF FLORIDA
STATE OF FLORI A OBI
COUNTY OF
COUNTY OF i
The forgoing instrument was acknowledged before me
this _ day of 20_ by
The forgoing instrument as acknowledged' before me
this � day of 71 +1 26_d by
jj
power 0460/!1
Name of person making statement.
Name of person making stat ment.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
nature of Notary Public- State of Florida )
Commission No. (Seal)
J=r
Commission No. Pubtle State of Pori
22 2 ¢J ( I Rae Langweiler
c3. My Commiulan GG 22526
REVIEWS
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DATE
RECEIVED
DATE
COMPLETED
kev.2/7/19