HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONX
All APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED �7
Date: /• O' f SCANNED Permit Number
BY EIVE
g �M St. Lucie County
Building Permit App
JUL 8 2019
y P Permitting Department
Plannin andDevelo Development
Building and Code Regulation Division St. Lucie County,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: x�,C/��/✓ ���y1QQ��
'PROPOSED'IMPROVENiENT.LOCATION
Property Tax ID #:
Site Plan Name:
Project Name: _
0 Q Q 7 / Lot No.fir/
Ll Block No.
OF WORK:
04090 cz6:/X/,r/G (ref dlGu/ <,,i">liril✓lU;
Additional work to be performed under this permit —check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
t/Electric _Plumbing _Sprinklers _Generator
Windows/Doors
Roof
Total Sq. Ft of Construction: 1 3 D SG� �r Sq. Ft. of First Floor:
Cost of Construction:$ /,21 rpo, �n Utilities: _Sewer _Septic Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name 'lh/L 441&5 I7 a /jEGSL
Name: t! �k / HvT661i11/s
Address;_%03/D r d C AA/ 3�� •
Company: lu'Je l nAnoe (fOf zj' /,r/G
City:` JEA!f SXA/ 6eh State: F4
Zip Code: Fax:
Phone No. ti KI' UJ
Address: ,.6 &-t5t5 .?c 6 SY
City: U14'fV7-- State:_.
Zip Code: Fax:
Phone No 2j)_ - 22,5- - 70/0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mai10,,46 14-441,1 P IIAMe-5 e, 6MIfIG • CD
State or County License C06 — 0 �-6 05-2
It value of construction is $Z500 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.
SUP,PI.�MENTAL- CONSTf2UCTkON l.tEM1I I.AW tNF0E2MATk0YPJ
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DESIGNER/ENGINEER:'
_ Not Applicable
'MORTGAGE COMPANY:
Not Applicable
Name:'. `'.
Name:
Address:
Address:
City:
State:
City:
State:
Zip: ;:nc Phone
Zip: Phone:
FEE SIMPLE -TITLE HOLDER:--, '
Not Applicable
BONDING COMPS .
Applicable
Name: f"�
Name:
_Not
Address: i " '
Address: of
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 INTIEW TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOURN CE DIP COMMENCEMENT."
Signature of Owner/ Lesee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA �//
STATE OF FLORIDA
COUNTY OF 1112r Al
COUNTY OF ( ) 0
The forgoing instrument was acknowledged before me
The forgoing instrumentwas acknowledge before me.
this 27 day of ✓� 20� by
this ""Iday of C) � 20 j by
skit% f�o-(�/� S
Name of person making statement.
Name of person making ftatement
Personally Known OR Produced Identification
Personally Known OR Produced Identification - v
Type of Identification
Type of Identifca ion
Produced e5d &.
Prod e
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ture of No State F CCI3
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REVIEWS
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REVIEW
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REVIEW
REVIEW
DATE
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DATE
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Rev. Z///15