HomeMy WebLinkAboutapplicationAll APPLICABLE INFOM,UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pie ' rce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
RECEIVED
Building Permit Applicatio BAN 17 2020
0
� ST. Luc P rmlttng
T. Lucie County, Permitting
Residential X
PROPOSED IMPR0VEMbNT'.,,L0CATl0W .
Address: Blvd, rar4 5,1tr04 WC1'&,, FL 3'1 q-r2
PropertyTax lD#: 3L4:UI2 oe)0.3 Lot No.
Site Plan Name: Block No.
Project Name:
.5 7
DETAILED QESCRlPTl0M0F'WORK:
om p o y r;nj g ra i"r itt rn X reft'd245e- 3: C1 M IJSift W004 AS fd rX ;179 014 I'kirete 'f tloq f4sf sefY �"1110M
in 1'X' a PPIX cc 4 I ye b6injjny gee is the nostog ir'oacrd.? rrJew,; I kW,,vt I I?+ the new pd it r- to in4tch
drive e
wey. swi di � 091- -tie fz'rs -k si Ie cf 4-A E, nw'sfz'oi5 s -wgik toVog the ;nclr'nemere streng 4A.
'Isp eg;)s *yff 4 di'iiMi 1*4 a lks"& 0-F T.5"' 12r- 44906 -rlreoglh.
1--c b"NSTRU-7-JoN, (NFORMATION-
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: Sq. Ft. of First Floor:_
Cost of Construction:$ g6�4'J),097 Utilities: —Sevver _Septic
Windows/Doors
Roof Pitch
Building Height:
.LESSEE::, �
OWNER/ - �' � - -' , - ' `: ' . - - ,
CONTRACTOM:T
T
NameMergviz R Oalfug
Name:
Address:- ASAlf JiffaiAiveah 'Olvd, A
Company:
city: ferk t-ueie State: F4
Zip Code: 3 1 q �,7 Fax:
Phone No. ?—7a - &f !r
Address:
City: State: —
Zip Code: Fax:
Phone No
—
E-Mail:— NA wil V71A & Ad4-fQ11J'1. Ct>J`7)
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
&Mail
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.
"v
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone -
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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."
R
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1 1
STATE OF FLORIDA
COUNTY OF �;k.
COUNTY OF
The forgoing instruqment was acknowledged before me
The forgoing instrument was acknowledged before me
thisf�dayof UPI" 20Mby
��mi° Y�fof.t (�Al l ,up
this _ day of 20_by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi n
Type of Identification
Produced — w��—
La�—
Produced
(Signattire of Notary PubTic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. KAREN SrcP1�GLSEN
f
Commission No. (Seal)
oa Florid o ary Public
E.e Commission # GG 207484
2
REVIEWS
PLANS
VEGETATION
SEATURTLE
MANGROVE
SOR
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19