HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONC
1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: ' �G% PermitNumber: /�VrZ `�
SCANNEDBY
• St. Lucie County
Building Permit Applic LPeirmitting
n MAY 17 2019
Planning and Development Services �e arL`ment
Building and Code Regulation Division p2300VirginiaAvenue,FortPierceFL34982 t. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Rrrtial ----
PERMITTYPE:
.PROPOSED IMPROVEMENT LOCATION:
Address: CkOU
1
Property Tax ID #: L4I I - �' LL3 - �' 000 -
Site Plan Name: // 4— ! Kl o
Project Name: OWAc� ri010 e61"
05MIM
Lot No.
Block No.
((W 3163 2 b:
CONSTRUCT,tON INFORIVIATIONs y '
Additional work to be performed under this permit - check all that apply: ,/
WindowsDoors
_Mechanical _Gas Tank V( _Gas Piping _Shutters /
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7.000 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE;- . ° ° = _
CONTRACTOR -
Name WZi
Name: Oi
S
Address: /t c.- ID,-. 0rA A3
`
Company: 1-;CAAHgoox m
a 1"
City: C. 1 Cfil�f State:
Zip Code: _?yf' Fax:
Phone No.
Address idol
Iw'4&v- -t)-. Xt y
City: Z5�1 k,- State: —
Zip Code: �t 6 Fax:
Phone No 7Z T85 Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail Co. br (i I'd • "
State or County License
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.
�SUPPLEMENTALCONSTRUCTION:LIEN LAW -INFORMATION: m
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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 COMMENCEMENTMAYRESULT-IN -YOUR _..PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED O E JO SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
Y R LENDE OR AN ATTORNEY BEFORE RECOR TOUR NO OF C MMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature o Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORT
COUNTY OF SY. Ll 1G4 —
COUNTY OF VA��
The forgoing instrument was acknowledged before me
YYl
The for oing instrument was acknowledged before me
this � day of � 204 by
this day of WW4 20�]J by
I�. nVI W11L4
LOVI W 11US
Name of person making statement.
Name of person making statement.
Personally Known —&-- OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of NotaryPubli - a
(Signature of Notary Pu ic- St '
•••" v'v'• ADDIE GNEEN
. o`r,P".: blic-State of Florida
Commission No. '_ • NQCI�: W COG 182849
•��n'r'v�^;. ADDIEGflEeo
Commission No. f?9; . e`�P3aSy Public -State of norl
( GG 182849
v < om is:ion
My Comm. Expires Feb 5,2022
s '' mission B
.',?oE My Comm. Expires Feb 5.20
•,,PFn,+ NotarvAssn.
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