HomeMy WebLinkAboutBuilding Permit Application I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -1�g...- 1
Permit Number: f9Oi L, 7
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NIMIIIIIIIINIMMINIIIIIIIIMMIMMI Building Permit Application APR 08?0s
Planning and Development Services Permittino 1.1.
sion
Building
Virginia Avenue,Fort Pierce' StFL 34982 Lu e Cp nay(Mt
2300
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential —
PERMIT TYPE:
PROPOSED IMPROVES LOCATIONg-°
Address: 1,5 'V•e rvt Ut C^ e--\, ,�
Property Tax ID#: 13 0 V. ( ( I CONQo'o IS Lot No.
Site Plan Name: Block No.
Project Name:
' MUM DESCRIPTION OF WORK: .,. o _ , °
"ear O-P4 Ad TDO/C-
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10 peal .k 5 C(' V 11 41{1 C• rn•cK )F 4 A c 3 o v b wer, Co(r rn —rto f, '� i►�y
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CONSTRUCTIONINFORMATt®NE r '
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers —Generator = v Roof 3/12 Pitch
Total Sq. Ft of Construction: 130b Sq. Ft. of First Floor:
Cost of Construction: $ 5190D,OD Utilities: _Sewer Septic Building Height:
NER E L@--SE .°. _ -4 a•. 't1 .Ie j
OW «� o ., ;;.
� ° °�- ,k• CONTRACTOR.
Natne Cho, (e5 9\;.( h Name: h-1 4 3 1 6OM ,- - , C d4
Address: p
-15 ` \/e,rCif \Jif-)'q Company: I►,✓1 J �J0� ° F
°Q a"� -
City: l'+ . ., ?i efc( , State: 4. Address: '(o9 3-,
Zip Code ''.. il.951 ; Fax: i City: Veep OcctGl,° State:
Phone No:.. _S .
.��a .... �.l Zip Code . Fax:
E-Mail: Phone Noy -•I 72 5-6Z -i i7o i ,
Fill in fee simple Title Holder on next page ( if different E-Mail `ph0 Grid g0vr rooky5- atf 4 j1e4'
from the Owner listed above) State or County License C.eC `3 Z6 77
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.
HOP • 1 CONS °UCTI®N Illal UM E PC)RMATIONo
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 represu
sentation that is granting a permit will authorize the permit holder to build thesubject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrictor 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 LEN 4 ER OR AN ATTORNEY BEFORE RECORDING YO R NOTICE7 COMMENCEMENT."
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Si, ature .f Owner/Lessee Contractor as Agent for Owner Sig .ture o Contractor/License Holder
STATE OF FLORIDA STATE e F FLORIDA
COUNTY r COUNTY OF '
OF e'" Lutcl E_
The forgoing instrumn�t.,was acknowledged before me
The for oing instrument was acknowledged be4fore me this g"day of L . — , 20 e`�by
this ) day of __— 0-- , 20 t7 by 1
v,,-,N„cciucs,,(
"l..`-v1/4, , Name of person m ing statement.-
Name
tatement:Name of person makatement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification Type of Identification Produced -F 1..„-
Type of Identification
Produced FL; a `�
? �J` (Signature,of Notary Public State of Florida )
(Signature of Notary Pub.' - �• :•. , ., Commission No. ? �l,��,, CLLEN VA GHN
�41 ELLEN VAUGHN a �CsState of Florida-Noter Public
p1�Y PU4 t �J., •; y
Commission No. a'=!:. o-State(Stali)rida-Notary Public ;y,� i ro:,; Commission #OG 27.0079
::•11M‘'E Commission # GG 27.0079 '. "-:i4'o11,i't°, My Commission Expires
s,,�o Lr: My Commle®ion Explree. October 22, 2022 .
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REVIEWS FRONT ZONING . SUPERVISORPLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19 .