HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: t 1 'a'5` �� Permit Number:
RECEI.VED
APR 2 b 2019
r F
Building Permit Applicati
r3T. Lucie County, permitting
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 Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: 10,1M ;&If,
Property Tax ID#: �✓3�( 80a--_"'001 �O �� '�� Lot No.
Site Plan Name: Block No.
Project Name: -%jW,K- FESS. LJAte-{(- .�� _1b sbp �lc�t%I>K)
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION IN!FR'R,'ION:
Additional,work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
ectric _Plumbing _Sprinklers _Generator _Roof. _'Pitch
Total Sq. Ft of Construction: /too Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNERRA LEMSE IfffliffNWIRTA0,00,R:
Name PO)OaU '6t tAN0-Vk Name: Ue- _
Address: t0';AOS ,�yLE PIS tt- Company: _TM PGAJ# EL ECNI(l u LL&
City: l��CEE State:_ Addrf�i
&It I E 5E
Zip Code: 'j �,C„ Fax: City: .'SIV W4 to State:Vt_
Phone No. a3,a: Zip Code: 5141 Fax:
E-Mail: �- Phone No :M-V L" 1-b4-0)
Fill in fee simple Title Holder on next page(if different E-Mail TH K f i%71
from the Owner listed above) State or County License 1(n
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 MENTAL CUNSTRf:ICTION LIEN LAW INFORMATf�ON:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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
WIT YOUR LENDER 90 AN ATTORNEY BEFORE RECORDING OUR NOTICE OFC MENCEMENT."
Signat re of ner/Lessee/C ntractor as Agent for Owner Signati5re of C tractor/License Ho r
STATE OF FLORIDA STATE OF FLORID
COUNTY COUNTY OF we-t
OF lyew;C rl
The forgoing instrument was acknowledged before me
The foEAoing instrument as acknowledged before me thisy of D F I 0LIJ by
this 9&-day of D ( I 20_1by
Name o persol
aking statement.
Nam of pers n making statem nt.
Personally Kno OR Prodyqed Identification
Personally Known 0 Produced Identification Type of Identification Produced
Type of Identification
Produced 1�—, L 0 L-
(Signature of Notary P lic-Stat
(Signature of Notary Pu ic-State of Florida) Commission N :fie. 1ss1oN# �a2pn
No."
�� pR1E 1.
ONES ?�' ., - E�CPIRES:DecePubl c Und�4enz!niters
Commission No.�r o {,c fjAM #oop22023 y Q gondedThruNotary
uYPUa OMt�hISS10N 1E:2020
MY C ;December d ry�fit
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REVIEWS FRON UPERVISOR PLANS . VEGETATION SEA TURTLE MANGROVE
COUNTE. ,REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19