HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED
SCANNED Permit Number:
-- — --- BY
J �' ` Lucie ce Countv
^ • --- E-RE-CE-IVED
BuildingPermit Applica on
JUL 31 2019
Planning and Development Services
Building and Code Regulation Division ST, Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial C Residential
PERMITTYPE: �OWo VA—'D,L
Address:
Property Tax IDtl: • ftj t U'L 7U1 UUUC7 ODULot No.
Site Plan Name: Mj2=t zs-- G 19"-f i\ Block No.
Project Name:
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
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER%LESSEE Nt 1
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ONkTRAGTOR:WAIMN
Name S
Name: MCa
Address:3901 0.-,mST4, dC =ti.l t ire
Company: t
City: MSSA RjC464 State: T7L
Zip Code: S4 q S:Q Fax:
Phone No. 22 Z
Address: 1102
City-,T>�y r, State•q----
Zip Code: Fax: -771- 44-1 �l31
Phone No T% 2-j D
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail tit Li ,h%cam O.R .l-4 ir,ali.
State or County License 3U�5�0ZCe
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.
SUPPLEMENTA CONSTRU�GTI LjEN L FORMA IONZa
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
lot Applicable
Name: AeK4(7kRCTtZ1CS
IPIL.
Name:
Address:
t3
Address:
City: IT
Stater
City:
State:
Zip Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not 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 ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF $rcvarl
ICOUNTYOF Rrcvard
The forgoing instrument was acknowledged before
The forgoing instrument was acknowledged before me
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this 24 day of Jvly 20 19 by
Q 0 W N
this 24 day of Jvly 2011 by
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Name of person making statement.
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Name of person making statement.
Personally Known k OR Produced Identifica
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Personally Known OR Produced Identification
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Type of Identification
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Type of Identification
, 2c0
Produced
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Produced
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(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
Commission No. LaG23419 (Seal)
Commission No. 467336R (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
'I
b
DATE
COMPLETED
Hev.2/7/19 t i