HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAtAPPLICABLE INFO MUST BE CO,-:. ^_ETED FOR APPLICATION TO BE ACCEPTL.:
Date: \D- 2: `S
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
SCANNED Permit Number: Z-i
BY RECEIVED
St. Lucie County
OCT o s zois
Building Permit ApplicationST Lucie County, Permitting
Commercial / Residential
PERMITTYPE: w'rtJ1)'4� S �DO�,v p
PROPOSED IMPROVEMENT LIDCATION: 0�� d
Address: 2 �J32 N�`r3 !�;`L01ko@—DA r 1� p
Property Tax ID #: L 2 D - 00\\\O - 000 '' % Lot No.
Site Plan Name: — znt Block No.
Project Name: 0,-A iZN 7
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: QQ I Xk sq. Ft. of First Floor: _
Cost of Construction: $ � 7 lQi P • 47 Utilities: _Sewer _Septic
_✓ Windows/Doors
Roof
Building Height:
Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name: O L
cA
Address: 9 P 4E WM001 IA..)
Company:
City: 'j(�MxLm State: T
Zip Code: Fax::
Phone No.�(y��IU0 - i
rft�D��lr
Address: T.S I S� �NM I,W 7Z'J
City: State:
Zip Code: �3Q C1Q Fax:
Phone No i'h - - '7Cj�j (qet
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail or)P) n'Zu., �1t�rSY7P�r� t��
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.
PPLEMENTAL CO
N LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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, swirhming 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 ATTORNEYABEFORE RECORDING YOURrNOTICE OF EOMMENCEMENT."
Jfure ofbw IVr/ Lessee/Contral"f r as -Agent for Owner
TE OF FLORIDA
1NTY OF
The forgoing instrument was acknowledgedbefore me
this Z day of der 20by
.Ab(;Ua,- -D�%Q�e_xkz .
Name of person making sta ement.
Personally Known OR Produced Identification
Type of fdentification
Prod end
(bignVture of Notary PublUrOk
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Notary Pulpit State of
LisCommission No. `F• MyyLis=Ii 'in FF1 E
or M1e� Expires 02/16/2020
REVIEWS FRONT I ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
OF Y OF FLORIDA
The forgoing instrument was cknowledged before me
this' kiayof a�� 20L�by
1'O& Did' � � ah� r' kku)
Name of person Makings tement.
Personally Known OR Produced Identification
Type of lclA ification
of Notary Public- State of Florida
mission No. �dNotepp��gg State of Florida
LlsaMMEBharalh
MY Commission FF 962709
REVIEW NS I VEGETATIEV EWON I SEATURTREVIEW EWLE I MREV EWVE