HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C-- �-`q SCANNED Permit Number: I d�r1' (0
BY
St. Lucie County RzCBNED
Building Permit Application AIN 04 2019
Planning and Development Services Po ti G�9 1)epartment
Building and Code Regulation Division c+e county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
PERMITTYPE:
oo'rionccri"mnonnvcnnrnir.:inrarinnl• °'- - _:- _ -' I
Address:
Property Tax ID #: 3535- - '7002 - 0 000 - 000 - rI Lot No.
Site Plan Name: Ce-eG1-n -%O w ecs Block No.
Project Name: goCe6LY1 1 b-W C_r5
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters -Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ q'F4 0
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
01AlNER/LESSEE:n , �, , ,
CONTRACTOR:
Name0CC0.11 DWer5 Nnt�ADS �J
Name:C_K(,S-k_* ie-hM.Q�i�
Address: rl',-DO � D C y'1 p' ILYL%/e.
n�_
Company: r)-V -CLf-f FeYLC& l_J(Vt O_CU*1Y
City: , e n :B e0-C/ % State: FL
Zip Code:,34 ^7 5 i Fax:
Phone No. Y47- (o'71- 3(0 Tb
Address:�_Q�J D X.. (0.4 (o
City: r+ Stater(.
Zip Code: 345'(f 5 Fax: �J7d-a88-3o35
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ®bel l A_I7u 46. n e_L
State or County License r %% ? -7?
If value of construction is 525Do or more, a RECUKU[U rvouce oT wmmencemena o ,equueu.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
cy,_,d CztI4 z1
SignkLuEwdf Ow Lessee/C ntractor as Agent for Owner Signa of Contractor ' en Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 0.Y �r ✓1 COUNTY OF
The forgoing instruTent was acknowledge �j before me The fo �9ing instrument was acknowledged before me
7%ay LLt Yl a 201a by
this X day of J Lkl l 2— 20 I�1 by this of �J
Me 5_k.r !el ahrn0--X0L
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification Personally Known t/ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary PubGca,SEe (Signature of Not 'c- S F '
i� Notary Public State d FloriEa v Na1ery P"Dib S of Fwdda.
Commission No. ' ao � Diane ®and ,t�St�
'IAgba,aa 286701 Commission No. e K Bond,
My
�orn Expim 12120/2022 ME Comm � �f
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19