HomeMy WebLinkAboutLacy permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: # Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 r
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential)
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION: I
Address
Property Tax ID #:
Site Plan Name: _
Project Name: _
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0( r - oo qE3, �;zc'r�'
.101
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
AdditMo I work to be performed under this permit –check all that apply::
Mechanical
__ Gas Tank _ Gas Piping Shutters Windows/Doors
Electric _ Plumbing —Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 5010 t 3 -2, Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name t! l
Name:
Address: llke bil.
Company: `e
✓C .
-.-A.5
City: State: FG
Zip Code: 3t( 9S ( Fax:
Phone No. 7�7� _ 37 j %
Address: DC7- �k,l
PA14 6 < .t;Z
City: �At E Stater
Zip Code: l ' Fax: 772 1,4101i!
Phone No ) 7- ' Vit, li
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-MailrtLL'
State or County LicenseC
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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. Lurie County makes no representation that is granting a permit will authorize thepermit 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 FI ST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEND A RNEY B ORE RECORDING YOUR NOTIC MMENCEMENT'
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Signature of Owner/ Lessee/C cto s Agent for Owner
Signature of Contractor/Lice e Frolder
STATE OF FLORIDA
STATE OF FLORIDA
04*�
COUNTY OF
COUNTY OF -
The for Ding instrume as acknowledged efore me
this r day of 20 by
The forgoing instrume was acknowledged efore me
this day of 20 bby
Name of person making state t_
Name of person making statement.
Personally Knowrf OR Produced Identification
Personally Known_ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
NMI/,CFIRIS WO
ODBERRY
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�,�:aiy�.,,� CHRIS Wt70DBERRY
ommission # FF 908943
:.� Commission # FF 908943
12, 2019
(Signature of Ntary P �r e�� ueooa�sro�s
(Signature of Notary Pu Frn kcwmsovrmi9
Commission No. 1 �(
Commission N i (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
rev. L/ !/ 19