HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE I eu FOR APPLICATION TO BE ACCEPTED
Date: f75-0k"t0J SCANNED Permit Number: v q
BY RECEIVED
�- St. Lucie County117 MAY 01 2019
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:
Address_2Dl GAMV VF'-LL i20
Property Tax ID #:
Site Plan Name:
Project Name:
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: I g 6tJ Sq. Ft. of First Floor: _
Cost of Construction: !WC). — Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
C � NTRgCTOR:
�e
Atl = (
mpany: v 6Nr ��111 ,V oanGNr
l�ess
A[ Y.;: i� j Q(L� State: V: —
�p Code: ?,�l�l Lf S Fax:
�l f )
Prho;eNo: �- 6- 7
K� clresss:2Ck CMNW*5'GLL
y t��tifSi)LC E State: �L
4,
i Code: ��q�5 Fax:
Rhone No =
E-Wall:
�i AA
p �l tc�r ����-AMottl •C_c�»1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
p772-LiID'lo=`^���0�
ail PJA-i f�r_�1� 0 � (vv�.1 . C,CNN�
S , e or County License CX.Cf 1a519 27
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.
SUPPLEMENIN: LCONST ION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _�20ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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 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. F YOU INTEND TO OBTAIN FINANCING, CONSULT
W LENDER n AN rORNEY BEFORE RECORDIN Y NOTICE OF COM ENCEMENT.-
ature of Q ner/ Lessee/Contractor as Agent for Owner 1 ature ontractbr/License Holder
STATE OF FLORIDA STA E OF FLORIDA /
COUNTY s� r COUNTY OF
The forgoing instrument was acknowledged efore me
this _(day of ��20_nby
Name of person makingKtatement.
Personally Known OR Produced Identification
Type of Identification ��
Produced ® L
(Signature ofTNotary Public- 56te of Florida )
The for oing instrument was acknowledged before me
this ay of _QQ 200L by
Name of person makingqatement.
Personally Known OR Prod ed Ide fication
Type of Identification Produced�
(Signature of Notary Public- State of Florida )
Commission No. I(Seal)
Commission No I LEN A$ HN "yo' ELLEN VAUGHN
„;State of Florida -Notary Public State of Florida-Notar Public
y •e Commission N GG 270079 5 ._ y
"' �t`P•` October 22, 2 2 s "%�3 . "„c° M Commisslon Expires
REVIEWS ISOR PLANS V 12b22 M GROVE
COUNTER REVIEW REVIEW REVIEW REVIE IEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19