HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �2 b S Permit Number:BY �� •� 5a.
SCANNED RECEIVED
• St. Lucie County SEP 2 6 pig
Building Permit Applicati �deleEeaRty penn!tting
Planning and Development Services'
Building and Cade Regulation Division
2900 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462=1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: 1l S2aa4✓ _ �e
Address: o0
PropertyTaxlD#: Zgoll- 60 ,0Z0i-0oo-1 Lot No.
Site Plan Name: A'n LF Qo W^ We 5 o6F.[.F 106 — Ill Block No.
Project Name:
-TEArl 6*:F Ill f ofl►n: (Zr-- A)o1L— aJ In , 1Rll�
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/D ors
_ Electric , Plumbing —Sprinklers _ Generator t/ Robf (2. Pitch
Total Sq. Ft of Construction: 7Q l as it k _ Sq. Ft, of First Floor:
—__
Cost of Construction$'frpn0 Utilities: —Sewer _Septic Building Height: •
Name�4 Lp—'yZoAcp WA-Lc*cII Qt^F.l~+z
Name: dfPJerL �160RtC ld
Company: Lgf:WA2Q 0061C, e,
Address: 6Z(v "5t,11 i1L1:—)2711rM &W
V City: INO OrIaGto StateFL''
Address:��7*j
Zip Code:'3,z-qLZ Fax:
city: —7E0L2f��le4tv State:
Phone No.
Zip Code: JZ95$ Fax: iT2-5M—Zg29
E-Mail:
Phone No_`l721 : iM' 2U60
Fill in fee simple Title Holder on next page (if different
E-Mail r Ci a r�
State or County License .k 2 614
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
N PLEM NOMATM CONS�TR..7 IIN ' BEN IIW IN�F
�.
IVIATIOI _
DESIGNER/ENGINEER: of Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable
Name:
BONDING COMPANY: _ of Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THEFIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LIENDER4R AN, ATTO N FORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signati re ofowner/ Lessee/Contractor as Agent for Owner
S gnature of ntracto�ense�tr
STATE OF FLORIDA /n
0. Pik$
STATE OF FLORIDA
COUNTY OF � A n c /
COUNTY OF -Lr,A_ n.+� w�✓
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this A^7 day of 20,d by
this Z"S�day of , 201` by
Name of person making statement.
Name of person making statement.
�OR
Personally Known V1_1�011 Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
L�J
D.U1a/✓I A�/�1
(Signature o
u ic-
(Signature o otaryPubl
Commission
"' L = MY COMMISSION 308
tiM
pgVID M GINN
'-:`
Commission No. - : = MY CCQ@ISEffi ION#GG055308
IRES January 25. 2t
'•,,.� EXPIRES January 25, 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
--
D
RECEI
DATE
COMPLETED
Rev.2/7/19
ST. Lucie County, Permitting