HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONit N
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Qh I ( L
Date: G' / g SCANNED Permit Number: / V 1 ' 0 I l2 7
s = � Lucie RECEIVE
St. Lucie County
io �
Building Permit App
Planning and Development services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE:
Address:
Property Tax ID #: 2YD Li — CaO R' 620) —WD'— II Lot No.
Site Plan Name: Block No.
Additional work to be performed under this permit —check all that apply:
_ /Er: echanical _ Gas Tank _ Gas Piping _ Shutters
lectric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: CQj0j birth Sq. Ft. of First Floor: _
Windows/Doors
_ Roof Pitch
AI) Pli
Cost of Construction: $ L 04 d • ba Utilities: Sewer _ Septic Building Height:
OVVNERJLESSEE* r u _'.
CONTRACTOR :- F
1
NameAn7}f Rn� Wayeb usP ^Cbmn1Pie L(.C.
Name:'bbhalci }}.
III
Address:6zu Sw 61c�,1Y\Xie {)V
Ct^r
Company:1AY4-Arg1± SIC,Y) Cb Dnt4, loc.
-
City: ?i8Qrig State:-�L
Zip Code: 32%,L Fax:
Phone No.
Address:21g:15 K,iVbu VLIe "'ir r
City:_PCI M J �4 State:_j.-
Zip Code: 32.9U 5 2Y10160
Phone No32)-72-7— 73ZY
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail rA yIa6 y? ck (0 Q x- -- k_y'F . P/)?vi
State or County License ES ) 2Unn 1 '7 O
If value of construction is 52500 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.
SUPPLEMENTALuCONSTRUCTION
LIEN LAW INF0
F
_ 'TIONT.
DESIGNER/ENGINEER:
Name:�i-LWe.11s CunSuj�i»a
_ Not Applicable
LI.C-�AnRPSWe-1
MORTGAGE COMPANY:
Name:
Not Applicable
Address: UL_v b;}�t S
Gi✓L)2
Address:
City: 8xii P[IIA
Zip: 127Ln 15r Phoneto-
State:
45(a-54 R4
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_#[Not Applicable
BONDING COMPANY:
Name:
XNot 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 contlict 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 LENI'JFR OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
S9::A:zk-%c(a�
Signature bf Owner Lessee/C tractor as g nt for Owner
Signature of Cont-r-a-cTo-r7Eic—e—ns-e-R-oTder
STATE OF FLORIDA
STATE OF FLOI DA t
COUNTY OFT� �,-, a,,r�
COUNTYOF I,rfVt, Y
The for oing instrument was acknowledged before me
1�- _S
The forgping instrument was acknowledged before me
S�5 `day '3'Uy\
t1hiis day of e . 20(1 by
this Z- , 20_Q by
of
1,,)
K�rK Ur`1/l �1-�:r�
I
kJnhYa`k FF- I�S;G
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓
Personally Known ^ OR Produced Identification
Type of 4Lentification
Type of Identification
Produced
Produced
SHERYL DEANNE GRIFFI
2
t 01
c•�b4� NON public - State
I
ignature of Notary Public-Stat Commission;IrGG
gnatur f Notary Pu �Fliabltlihjssion H GG 11994
-,;? Fac My Commission Expires
wit. ' My Comm. EVkft Feb
wn
Commission No. )1 """I ne 28, 2021
emraupel
mmission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119