HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 `aJr' SCANNED Permit Number:
BY
St. Lucie Countv
152019
Building Permit ApplicEUOMEPPlanning
and Development Services
Building and Code Regulation Division tting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
a `a
PROPOSED IMPROVEMENT LO@ANION:
Address: 1O AD as M 41 814 �- L{IJ 0
Property TeX ID ii: 39 H - 50 i - 6-60 4 - 95-0 --7 Lot No.
Site Plan Name: 50,AP0,4 phi-24 Block No.
Project Name: 5 oJk p6r4
DETrAILED DESCRIPTION OF WORK:
II
Dr. Q Cce iv ( wrote
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
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r�
Cost of Construction: $ ao 0C% Utilities: _Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name iflell 40 (kn,, s L-Lc
Name: on
ut—
Address: ) k'&` : d
r;�e
Company: Cons
City: State:l= (
Addressa. hU '80
City: �� ey7�'r e4ti - State:
Zip Code: Fax: t:. ' I'•
Phone No.
Zip Code: 73a %fie` Fax: 709- (?9-S(oS�
E-Mail:
Phone No -1)2-'T-79-S65-6
Fill in fee simple Title Holder on next page ( if different
E-Mail G!wd:a,, Covsl,,cha, 4Q f �n , Lo+-
State or County License
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.
SUPPL ME TrAL CONSTRUCTION LIEN LAW INFO
M T ON:
MORTGAGE COMPANY: Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 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 Contractor/License ITolder
Signature of Owner/ Lessee/Contractor as'Agent for Owner
STATE OF FLORIDA
'%R,
STATE OF FLORIPPA
COUNTY OF Vu
COUNTY OF 0e�'R
The oon�ggoing instrument was acknowledg before me
The forgoing instrument was acknowledged before me
this? day of �,z Dz 20't% by
this aS day ofg D 6 20A by
A h-(O V%'X 5 G'.a cd: v%o
'P''^'�'r ic"n:a G', o,ta+►,n�
Name,of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
L
Type of Identification
Produced D
Produced
p2�5i ature of N ic-Stat9W �GG b72023
(Signature of Notary P lic-State of Florida O'GN
/ DFANe\ONNCaG6
Commission No.VGd�..a.d v'",.�.'*.,jSejf CAM S.Da�mc
20 �.�5'"'°: pIY COMtd1SpS01�n16.2020 1
c�Ni5i 'ssion No.
•xi �I�NoteN�
`•', o fig:` S
%`,R'„t'
REVIEWS
FRONT
SUPERVISOR
PLANS.
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19