HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t45--:W SCANNED Permit Number: 1q\O Ol S Q
BY RECEIVED
_)t. Lucie County°
• , OCT 3 1 7.Di9
Building Permit Applic tion�oc.mrEt rerml lns
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ZlIesidential
PERMITTYPE:
Address: 1 DD(o S
-0aerov u
1—. ST. t.0c:e , 1' C
PropertyTaxlD#: �J�4a-�3d-Ocla��d00-� Lot No.
Site Plan Name: Block No.
Project Name:
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:
Cost of Construction: $ X l)
Name actr'vz- 6r:r•
oa
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Address: 3DO3 Of
City: t 1 • P -o-r(p State:fL
Zip -Code:. 3 `t q 4l. Fax:
Phone No. ctot-1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
f value of construction is 52500 or more. a RECORDED Notice
Name: LDo.-c-s
Windows/Doors
Roof Pitch
Building Height:
Company: Qv e 1 910 r--�D:n
Address: q-1 IS S - v S Os,� 1
City: TT- P.-orCE State: (•
Zip Code; 3 ctol 1sa Fax: � R
Phone No --I -) 7- - (P 7, 1 - S2.Fr?
E-Mail f'�e � Ply & ( pN ;l_ ri
State or County License C FC W act 31 W
is required
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
13
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SUPP � � rA GONSTRUC�TfE17(��E.1E l�AW INFORMAT�Q
DESIGNER/ENGINEER: _ Not Applicable
Name:
�
MORTGAGE COMPANY: _ 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
POSTEO`UN THE JOB SITE BEFORE THE F ST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH,Y LENDER OR AN ATT Y ORE RECORDING YOUR NOTIC F COMMENCEME '
r
f
Sign of Ow r/ Lessee/Contr&for as Agent for Owner
Signatur f Contractor/Lic-Tse Holder
STATE OF IF RIDA
STATE OF FLORIDA
COUNTY OF I u. r. jr\
COUNTY OF r -A : n
The forp�oing instrument was acknowledged before me
The forgo-ing instrum_^eLnt, was acknowledged before me
this�D day of Oc,tdb�e .20M by
this'0d day of (X�� ,200 by
-sc 61—.� S
a o- r�\ %-err.• S
Name of person making statement.
Name of person making statement.
c'�
�OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identification
Type of Identification
Produced
Produced
..AQ- � `-
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y
`R.a,�, �PP
Sig ature of Notary Public- State of Florida)
(Signature of Notary Public- State of
No.C, 4
llotary Public StaCommission
missionNo.0 G 31e74da Kerri Lee HiteNotary
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Public State of Florio
My Commluion 6Kern
Expire, 08/19202
Lee Hite
REVIEWS
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Expi
s 08/19/2023
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VEGETATION
SEA TURTLE
MANGROVE
COUNTER
RE I
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2///19
ap Notary Public State cifFlorida
Kerd Lee Hite
p c My Commission GG 387402
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