HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5—x~v. Permit Number: lgt'J 6—b1) 15
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Building Permit. Application 4 `�
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 X
PERMIT TYPE:
PROPOSED IMPROVEMENT.'LOCATION_M1 ` r
Address: S ! yZ'/, or, 10' ; .
Property Tax ID#: 314(D'a_. 00(,- ooCj -0001 r --- Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF-WORK -,
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CONSTRUCTION INFORL.MATION ;
Additional work to be performed underthis permit-check all that apply:
pz‘echanical _Gas Tank —Gas Piping -Shutters Windows/Doors
—Electric —Plumbing . _Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
GG I ,
Cost of Construction:$ CO�Gd ' Utilities: Sewer _Septic Building Height:
OWNER/LESSEE - _. ; . . CONTRACTOR , ...
Name 0 fp / e fc /1 Name: /
Address: 'b� / ?/f' 0 r r I�' Company: /L/
� / /' JO jai,�p/A S'
City: (-p r� i'P t Cr ( State:E 1 ,Address Y// / Lc� ?()?ti l`t l/6
ZipCode: ... , 8 Fax: . . City: ('ij k p e c t cv Stater
Phone No. 92 - 337- Z775" - Zip Code: ,5 yy57 VFax:
E-Mail: Phone No G:3... .' ‘f3- ‘ 203
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License ('AC / l ev
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.
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SUPPLEMENTALONSTRVETIO
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CONSTRUCTION LIEW LAWINFORMATIONV4 •
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
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Name: Name:
Address: Address:
- City: : City: - .. _
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Zip: - - - Phone:'' Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated. I
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 andreview your 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,wqls,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 I END TO OBTAIN FINANCING, CONSULT
W' It YOU' ENDER OR AN ATTORNEY BEFORE RECORDING UR NOT C OF COMMENCEMENT:' , :._ ' _
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Sig .14'7Ure •Vi n-V Lessee/Contractor as Agent for Owner Sign tu e of C,, r. or/License Holder
STATE OF FLORIDA --1 STATE OF FLORIDA , ,ILLciT "
COUNTY OF - (--rt- LAA_CD-._:- • COUNTY OF - Li%
The forgoing instrument was acknowledgecLbefore Me' .. The forgoing instrument was acknowledged before me °' • ' .
this - clay of ,(''N(‘P ick___,201.4by this '.. of INA- '1 ,20,q_ by •,. ,,
..,T..-.....„ .
9 5\ S 'Me &-t tVit64X, Ck5A N5 csien_ck CI 7 MI cliiiNI?
' Name of person making statement Name of person Making statement.
- _
Personally Known OR Produced Identification Personally Known , OR,Prodyced Identification
Type of Identification r- , Type of Identification ,s'i .-
Produced . _ .. r-LL). 1_, , . Produced- . 'r-t—,
(Signature ofNotaryfublic-$ ate of Florida I :.-.. ' (signature 90c-..,..,,,,Sprida Y '
„0!:%.v*,„ : ELL VAUGHN ,, . . ,,,T4*,„ ELLEN VAUGMan. :
Commission No. ,pile d',-*?.-
ate of FLS ?)-Notary Public :CommiSsion, :apsopik,--_-- tati,)nf Finrida-NotaWWdlia
,, *E Commission #GG 270079 - , =*.P'- *:-:- Commission #GG,270079
14- My Cominis'Siop Expires 7=74101;74$ My Commission Exoir's
'ffne uctober itr22 , ; : • !'I - . . !)ctober 22, 2022
REVIEWS ,F . , NING , SUPERVISOR PLANS A 10 A io , A N ROVE
-- COUNTER REVIEW - —REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
, .
RECEIVED, : : '- . . : - • '''
DATE : .
: _
COMPLETED
key,2/7/19
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