HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Nui
BY
St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
I I M
Building Permit Appli lation . AUG 2 6 2019
ermitting Department
St. Lucie County, FL
Commercial Residential
I PERMITTYPE: TTO )CO-0 )� J N & I
LOCATION:
Property Tax ID #: Quao ILAQwA Lot No.
Site Plan Name:
Project Name:_ PXK�km
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Block No.
—Mechanical — GasTank Gas Piping — Shutters Windows/Doors
— Electric — Plumbing — Sprinklers — Generator t17Roof Pitch
Total Sq. Ft of Construction: I 9� I Cob
Cost of Construction: $ kAq(o W8. Lu
I
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name-VpaAQC� PCce�
Name =jZ Wgy)�ra
Adclressp��A-k"
AA4�c
C(
CltyA [\Sun QQ%-�" StateNL
ZipCode:aata .—Fax:
Phone No. CM2-) Q%n -�- 1kc(0
Adclress&—&93K�
City.u'\(�%bA— State7Y,
Zip Code: 19N5� Fax:
Phone NoQG5Q)L&K--54-ZA
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E-Mail�,�J(o &, Ga-A
Fill in fee simple Title Holder on next pige if different
from the Owner listed above)
E-Ma
State or County License CMLX��(495
If value of construction Is $200 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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DESIGr NotApplicable MORTGAGE COMPANY: Not Applicable
.�EER/ENGINEER:
Name:� Name:
Add ms:- unc2p �S- IJ Address:
City: 1* ti cle State: r/ City: State:
zip: :1_ Ph 3ne-#77�
Zip: — Phone: —
FEE SIMPLE TITLE HOLDER: _Not Applicable --iONDING
COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phon—e:
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 Coun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conl7lict with any applicable Home Owners Association rules, bylaws or and
covenants that ma estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictio w
ns Yhr c h 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 the Florida
plans, 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."
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FL A STATE OF FLORIDA
COUNTYOF 't (Y�% -t)ck,-\P-
COUNTYOF ak
The forgoing instrument was acknowledged before me The forgoing instrument wos acknowledged before me
this,;Zi day of IlLl� 2011 by this
_;25 day of 204 by
Name of person making statement. Name of person making statement.
Personally Known _ OR Produced Identification Personally Known ced Identification V/
Type of Identification If
Typde icat n
Produce ce 44b
Pro Z C)
Rebeca M Pastra la 4iV fte, Rebe rA h
...... QQQ61 4 naL
(Signature f NWary Mblic- Statiq6f
E Feb. �, @1fignatureo t Ii A
xplres..
Commission thru Aaron N( Expires. b. 20 Expirm Fi
taPommission
No. .. ilk ealpnded Bondei t i't
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
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RECEIVED
DATE
COMPLETED
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