HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n
Date: 7:7;) — 1Q SCANNED Permit Number:
BY RCCMVED
St. Lucie County JUL 0,.3 20ig
Departm
Building Permit Application Peng st Lucie co ntyent
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
Commercial _)_ Residential
Address: WJ!24! 1-hirY, 1—n F-+ W1 a r-c-.L-i FL I `10 WeEk-Af m Ln •
PropertyTaxlD#:C..)QIa- 500'001a-c60-9 Lot No. F7
Site Plan Name://Cf%� -� P Ulf Block No.
L Project Name: t1t CJ FeDCe
CONSTRUCTION 'INFORMATION: _
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: Sq. Ft. of First Floor: _
Cost of Construction: $ CIO Utilities: _Sewer _Septic
Windows/Doors
_ Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
-
Name:
Addr{es�sA��TBI myJ �I�+ � I
Company: d
City: I TIpow I Stater„
Zip Code::?)W(Dq_ Fax:
Phone No.
Address:11�1�1E 04-h
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City:Ogem
Zip Code:alJCl1&
Phone No M-Q%Q--/�5
State:
Fax..gw-- -yoy
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E-Mail: m�i
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MaillLlii2.ladf!"YlRtam
A) ckoh Ctw
State or County License 059%
1
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.
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SUPPLE'MENTAL°CONSTRUCTION
LIEN
LAUd INFORMATION
r r
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
BONDING COMPANY:
XNot 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 AWORK f BEFORE RECORDING YOUR NOTICE OF COMMAEMW
0
as Agent for Owner
STATE OF FLORIDA I STATE OF FLORID��
COUNTY OF mbee COUNTY OF
_, C`�'C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
d thispday of jJN , 2EA by thisday ofCkIly 20jq by
96ss A. ChnJrr►brxs lzem% A- C1atlakers
Name of person making statement. Name of person making statement.
Personally Known x OR Produced Identification
Type of Identification
Personally Known k OR Produced Identification
Type of Identification
of
Commission No sir""'""'JULIE SNELL ..:.
w.(SMA Public Flori mmission No. I :;"N"!'% (Seal) JULIE SNI'
1^+ ry 4r'i
A
Commissionk GG 1958771 t N Commission
.. it a
" ° .3;<
`.4 cy;: M Comm. Expires Mar 13,28 2
"'" Bondedth ough National Notary 4ssn. r '"'; `•
REVIEWS FRONT S NS VEGETATION ' sr
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
COMPLETED
JULIESNELL
Notary Public -state of Florida
(•nmmission d GG 195877