HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:-n Permit Number:
p 12 RECEIVED
Building Permit Application
Planning and Development Services SCANNED Sr. Lucie County, Permlttl09
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL34982 St. Lucie Counter
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial, Residential
PERMIT TYPE:
PROPOSED I PROUEMENT LOCATION:
ddress: 1 YY� NI"TTLCS 2&Vd. :r64 )S6.,J bACA 34FJ.5r7
petty Tax ID # �t�7• p� OL/ 62M CO(I. q Lot No.
Site Plan Name: Block No.
Project Name:
RE T LED DESCRIPTION OF WORK: 1�
- 5 & waap uvlal, jAi Tc.. M
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
I_
fallomn-gffFq -froiL��3t�ruc�tion::� % Sq. Ft. of First Floor:
�I
Co 0 onstracnorr> �'!/(N/, in Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name zaj&F'/ H to I lr
Name: i
Company:
Address: 1333 L�1 Aivc9.
lI�/>~Tr
City: ,Tg 4 SF.N 12:�f-ACA State: L ,(a
Zip Code: `54q Sri Fax:'1'Id-�,.$ I - -45I bS
Address:
City:
f 2 L10/p 1351
No. %r/ol- a9/�ate"
Zip Code:=••--_-,a_._-._,__-.�
Phone No
LhMo.ne
ail:SEF�ii UESI�I�r �rMA! L • Crsrrt
p e Title Holder on ndxt page ( if different
E-Mail
_
from the Owner listed above)
State or County License
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.
SUPPLEMENTALGONSTRUCTION I LIEN LAW INFORMATION:
DESIGNE/
Name: (e
GIN Fy� ,f
1 VVI t
_ Not Applicable
r .
MORTGAGE COMPANY: _ Not Applicable
Name: r—_. i
Add re :
Al
Agdcgks:,`, /l
City:
Zip: Pl
( eta e�
City:1 •' ° State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 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 SITk-BEFORE THE,FIRST INSPECTION. IF YOUJNTEND TO OBTAIN FINANCING; CONSU�Y
WITH OUR LENDER•OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF -COMMENCEMENT."
I
a -w
Lessee/Contractor as A r Owner
Signature of Contractor/License Holder ii
STATE OF FL
RI �E
STATE OF FLORIDA
COUNTY OF
-403'
COUNTY OF
The forgoing instru
day
en was acknowledgegefore me
The forgoing instrument was acknowledged before me
this of
20 by
this day of 20_ by
. 6 �O2v
lltzslnQ
Name &%ArsoA
making stateme .
Name of person making statement.
V.
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Idenr;dLcafion
Type of Identification
Produced
Produced
5,10
(Signature ture of�LSEN
(Signature of Notary Public- State of Florida )
unu
",
°c State of Florida -Notary Public
Commission N
" ission *580)207484
Commission No. (Seal)
My commission Expires
°,;``� June 12, 2022
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Rev. 217719