HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLII, .:OR APPLICATION TO BE ACCEPTED
Date: 5-15-19r SCANNED Permit Number: Lq O
BY
,t. Lucie County RECEIVED
MAY 15 1019'
Building Permit Application
Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
I,PROPOSED INPROVEMENT LOCATIOW *:. F` _: s k ; ,YJ
Address:
Property Tax ID #: ' I f _ X. Woq=� 0O-UCJD f U
pp ImoI
Site Plan Name: Jv�r i G, PUD
Project Name:
Lot No.
Block No.
z
bETAlib DESCRIPTIONOF K.41
?"-QNSTFtUCTION;(NFQif VMATION: J•`
Additional work to be performed under this permit- check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 4 cL l Cx) 0
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNERJLESSE(!:`°
.CQNTRACT'pR:
Name Sl'L'A a Cq,5N(nnCJc-3 �-55cv
Name:
P
Address: 9 SOU; S Oc [1/l
Company: ai vr,, Cc 1, cUc) I + S,n G
City:. State: C�L
Zip Code: -5`K'SM ;, Fax:
Phone No��a - 'Lf F2 i9 33 9
Addreslsn323`7 &L(i -0- Lip 11 6Z
City: State: PL
Zip Code: '?1t. R`? U Fax: '-7i 1- o21-rf7 � 3�
Phone No 71 - abo- a`2--70
E-Mail:_'kSLtA-S% ok, A0L. Catvt
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail L (M 121C- PCX� L e Rc) L o pk,
State or County Licensers 10C JOS c i 7
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.
2
SUf'P,LE ENT,4L CANS
33��
¢t i.F_.' �£4% „?9'z
t(�)V LIEN LAW
y
n#".
INFp,R QTIO
d j+
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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.
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 jobsite
before the first inspection. If you intend to obtain financing, consult with let<Jkler or an attorney before
commencing work or recording your Notice of Commencement.
- v
as Agent for Owner
OF FLORIDA
rY OF
forgoing instrument was acknowledged before me
_ day of 20_ by
of
person making statement.
STATE OF FLORIDA
COUNTY OF m o r-'-1 v-\
The forgoing instrument was acknowledged before me
this Jj .6day of M a V 20_1_�J by
Cost-r+ M,Lkrr
Name of person making statement.
Known OR Produced Identification Personally Known OR Produced Identification J_
ntification Type of Identification
Produced !0r,,ierS Lk CenSC
P Notary Public- State of Florida )
No. (Seal)
REVIEWS I FRONT ZONING
COUNTER REVIEW
(Signature of Notary Public- State of Florida )
Commission No. 1 °I 3 1 $ �
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
up: o deal) BENtIEPALmo
??° ''s NotaryPublic—State of Fl
rid
Commission q GG 1931 E
6
' �®ad
threw®hN�tl®nalNaW
A
SE
REVIEW
REVIEW
SUPPLEMENTAL
CQNSTRUCTIQNLIENLAW�INFQRMATIQN,�
�. � r,' ,
DESIGNER/ENGINEER:
Name:
Not Applicable I
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone
State:
!Address:
City:
( Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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.
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 accordancewith the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full mncurrency 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 CDR
TWICE FOR. IMPROVEMENTS TO. YOUR PROPERTY. A NOTICE OF
POSTED. ON THE. JOB SyE BEFORE THE FIRST INSPECTION. IF Y(
as Agent for Owner
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF � r-6 y\ COUNTY OF M o' - n
The forgoing instrument was acknowledged before me
this L'�_ day of tK� a_T _, 20� by
Ac-,2 V
Name of person making statement.
The forgoing instrument was acknowledged before me
this !_ day of Ht, 126Lt by
Qom� ' \\"
Name of person making statement.
Personally Known
Personal
Personally Known OR Produced Identification CV —
Trod of Identificati n
': ,•:
J:YRJGUNG
Notary—e-Srateofflalda
Type of Identification
Produced
mminioniGG073aT0
produced .
My Comm•5r0ves!Nu2G2011
BmdedUum k�iroalNMIAtr,
CK
$USnNSI-Aecry
Staten
Public•
ommission S GG 31
E�:
t(SigagFuir of otaryu
is-S too Fl rida
(Signature of Notary Public-StaComm. Expues.xal
rough National No
Commission No.
Seal)
Commission NotTF�15S�L (Seal)
REVIEWS EGETATIATURTANGRO
I COUNTER ROEVIEW S REVIEW PERVISOR REVIEW I V REVIEWON I SEEV EWLE I MREVIEWVE
117.011-4