HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
SCANNED
BY RErq
St. Lucie County j(/�j`
0 s
Building Permit Application NeS;�n
?1119"
Planning and Development Services St• Lu P Cpartoun ent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial A Residential
PERMITTYPE: Rem+aae.�
PROPOSED IMPROUEMEN)T LOCATjION: may.
MUVI GJJ. . V T
Property Tax ID #:
Site Plan Name: _
Project Name: _
k7
UVMbina f]s 6J2r plains nveV6CLek.
Lot No.
Block No.
Additional work to be performed underthispermit- checkallthatapply:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_1//Electric -V/Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: k 100 S�F.-Sq. Ft. of First Floor: SGMI e.
Cost of Construction: $ 2.1i 000 Utilities: ✓Sewer _Septic Building Height: ODA
OWNER/LESSEE:
CONTRAcmw
Name M;ldred 71>oStoO
Name: S-teyeAisoI
Address: 10410 004k% Dr. # 707
—Chris
Company: r,.S shvtvls'i ) IN xwe-
City: .`T2 vt Se h Geq 6k State: -IFA
Zip Code: Fak. "
Phone No. %72- 2dr/'-'79/9'
Address: 4WI St*14l'k- D+,. &- •evK. uC/.
Citys�'Ft. P'ev%ee....� State:jEZ.
Zip�Code: 3-41M Fax: P4
"Phone No
E-Mail: px-ealk�(a7 wdt koo • Gon11.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 'CNOSA1E VATS '0 f)Oo . COA %
State or County License C B G O 350 3 j
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.
SUPPLEME-NTALCONST UCfIO.N ILIIEN LAW IN
Fig RMATIO
DESIGNER/ENGINEER: _ Not Applicable
Name: Z[)W"0+- palyl5
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: /04.S S£ Rtvt✓S14f Dr.
Address:
City: S}-u a Wr- F 1. State:
Zip: 3g.q/p' Phone 772-781—(p(o9�
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: '
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 workwd 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 eit holder to build the subject structure
which is in conflict with any applicable Home Owners Association roles; bylaws oyangprmcovenantslhat 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.r on -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 I'OUR NOTICE OVCOMMENCEMENT." ,• —
�f/"(v�Wr— '.. ..'•
.. Y�/✓l UC�/VIP ..
Signature of Cont or/License Holder
Signature of wner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 1 , .
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrumentwas acknowledged before me
this �day �off 20_ by
`l V UtOJIs•��� � nr�Af\
this (Vday of 20_ by
`�'��uti- �0 uow.o-orb.
Name of person making statement.
Name of person making statement.
Personally, Known OR Produced Identification v
Personally Known OR Produced Identificationy
Type of Identification -
Type of Identification t•1,•-
Produced VL ZA,�
Produced 'FL 11JJ
(Nna ure of Nbta"ry Public -.St a bf•Florida•)•*.
(Signature of Notary Publi tat'e of Florida")
Commission No. (Seal) • :.
Cc mrr�' ' "• LASHMNAINGRAM-RAHMIN a I)
Z "a'r •.I ARHAHNAiNGRAM•RAHMING
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REVIEW
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REVIEW REVIEW
DATE
RECEIVED'`
DATE
COMPLETED
Rev.Z/7/19