HomeMy WebLinkAboutBuilding Permit Application i
1 -
All APPLICABLE.INFO MUST BE COMPLETED FOR APPLICATION TO,BE.ACCEPTED
.Date: 61 -1 Permit Number,:
RECEIVED
JUN 21 2099
Building Permit ApPl.ica ion.
Planning and Development Services ST. Lucie County, Permitting
Building:and Code Regulation;Division
2300 Virginia Avenue,F&t.p erce'FL 34982:
Phone. (772)462=1553. Fax..•(772).462-1578 Commercial Residential'
PERMIT TYPE:
y rr - -. -
Address: G
Property Tax ID,#: c„ 51415- 06-95 Lot No.
Site Plan Name; - Block No..
Project Name:
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Additional work to be performed under this permit-check all that apply.:
.Mechanical ,Gas Tarik. _Gas;Piping _Shutters _Windows/Doors:
Electric _'131umnbing _Sprinklers, _.Generator Pof OV`�b'r Pitch
Total Sq..Ft of•Construction
(� `[Q� Sq..Ft,gf;First Floor
Cost.of Construction:$ ( utilities: -_Sewer _Septic, Building H,elght:
s
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Compa.riy -e . . �.
City: — ' Stater ; Address: t
Zip Cad _ Fax?, City: .4q
A P rc State
Phone No.�"7 r7-1.3-- r1 4 a 3. ^ ' Zip Code:; Fax:
E-Mail: Phone No -
Fill in fee simple Title Holderon next page(if.different E-Mail
from the Owner listed above) State;or-County License1-4
If value of construction:is:$250.6 or more,a RECORDED Notice of Commencement is.required.
If value,of HVAC is$7500.or more,a RECORDED Notice of Commencementis required..
PP :: Not Applicable
DESIGNER/ENGINEER: _Not.A licable MORTGAGE COMPANY
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. Lu.cie: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 orprohlbit 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, Ido hereby agree that,I will,in all respects, perform the work
in.accordance with the approved plans,the Florida Build.ing�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 iNOTICE OF
COMMi-ACEMENT MAY pRESULRT IN YOURS PAYING TWICE FOR.
EP RECORDS S NDOPOS RE.
EON HE OB SITEOB FO EE TI E. FIRST
INSPECTION. IF YOU INTEND TO OBTAIN .FINANCING CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Signae of Owner/Lessee/Contractor as,Agent for Owner Sign a
turt ,e of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY COUNTY:OF
OF bar . L p<',.-2
The.forgoinginstrument was acknowledged before me
The forgoing instrument was acknowledged.before me this a-\ day.of Jy vie 20 A by
thisal dayof by
I NJ a•f %JN a►yo,--S,. Name of person making statement.
Narne:of person rriaking•statement. `
Personally Known:. DR Produced Identification
Personally Known OR.Produced Identification Type of Identification Produced L A 1.
Type of Identification
Produced L-
(Signature o 'rt' t sau
[:4ISSION#GG 022023
(Signature of Nota Publ c St to of. rel: o' mission `ci.; ` IR3B:Deremborl(�� 1)
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[)[-:ANNA MARIE GIVENS - Bonded Thru Notzry Public Lndenvriters
7r?i ' P'3`�= Ofv1tdISSION#GG o22(23
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Commission No. (SIr
T ~ EXPIRES:December 16,2020
Plotz Pcblic underIJzite s,
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REVIEWS FRONT ZONING SUP.ERVISO,R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ,
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