HomeMy WebLinkAboutBuilding Permit Application All APPLICABjLEIN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �? 1�$ �lCX Permit Number:
COUNTY
- - - Building Permit Application
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
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PERMITTYPE:
PROPOSED`IMPROVEMENT LOCATION': .
Address: —7O a, fi n,Kn S
PropertyTaxlD#: - CMG()-- -7 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DE5CRIPTION OF WORK:.
7 ns41 l A +0A-4 OP 041 a P 1-! ` ch "71N PC e
In VC-rri"0C,t(I�cc,c, in +11e Pargem,fV bo comcc-r f G 11e ean's ti'�rn,
GLIGir1 Lull-s AA cC)kn,Vv1 On DfAw,
CONSTRUCTION INFORMATION: 7771
Additional 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:$ I}ck00,UG Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name rArAe,S s` Apje_ v 1 Name: .511e0avl (SrfsM
Address: _702 Avii 6h Company: (Z, (r G. elr �CnoQc'
City: �U� ���ee_. -state:f'L. Address: 3 L.6t5j 1K%yej'" 1) r•
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Zip Code: '3�(r1.$e?— Fax: City: F-4 • f scree-- State:PL-
Phone No. ac-1 '-3q(e Z Zip Code: 'l4H C Fax:
E-Mail: Phone No 3_:)-1- 7 )-!o
Fill in fee simple Title Holder on next page(if different E-MailXr
from the Owner listed above) State or County License 21 S? 3
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.
SOPP,LE=MENTAL CONSTRUCTION LIEN.LAW INFORMATION
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 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
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"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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Fg ure of,Owner/Lessee/Contractor as Agent for Owner Signature ct /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF -', g r �>
The forgoing instr ent was acknowledged before me The fo oing ins rument was acknowledged before me
,
thisday of t 20a by this�� day 9: 0 2Q by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Sig ture of Notary Public- tate f Florida) (Signature of Notary Public-St o
. �ING�_RAHpA1N
Commission No. r .. Commission No.: LpSFIANMIssIOr(���I 75060
s s+?y LASHAHNAING AM BANNING *' SPIRES: )ecember"2 2p22
MY COMMISSION#GG 275060 *:
_ w., ;'o`; ublicUndetwdters
• r•OFF,��
EXPIRES:Dece er •,,F �,. °� ...�
REVIEWS F �'�fiFe� a °�ryP PLANS VEG SEA TURTLE MANGROVE
C 59MIM REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
L
ED
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