HomeMy WebLinkAboutBuilding Permit Application r ,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (q03-p
Date: " [ 3" L9 Permit Number:
st' "r RECEIVED
' AUG 13 2020
Building Permit Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St.Lucie County
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMITTYPE:
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Address: f(o 0a-5 PefYi cc),c. i- P
Property Tax ID#: L11 0 -5 23 b 33 Lf- 0 (,Is C Lot No. 3 �
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 Tank _ _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof 2 Pitch
Total Sq. Ft of Construction: Z GDO �� `T- Sq.Ft.of First Floor:
Cost of Construction:$ \-3 Utilities: —Sewer _Septic Building Height:
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j Names db C• �,,lSo n5k nk ulgs Name: „a�i\�
Address: S Q��k� C c.1►� p� Company:J <�-�9S L
City: J,<- et •e ut- State-V-1— Address:1 3 5k,-! Cs( ' e S
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Zip Code: 3 c� !�� Fax: City: Qc>S ��t L.�c: < State:,
Phone No. Zip Code: 3`f 1 Fax:
E-Mail: Phone No-1 S
Fill in fee simple Title Holder on next page(if different E-Mail S ktt rte neCc,'0Siy\ D 1,4 qin v. C'�'
from the Owner listed above) State or County LicenseC+C-C-W 110
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. i
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
1 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 Count 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'i
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 OUR LENDER OR AN ATTORNEY BEFORE RECORDING NOTICE OF COMMS MENT."
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Signature of Owner/lessee/Contra s Agent for Owner Signature of Contractor/License H de
STATE OF FLORIDA STATE OF FLORIDk1
COUNTY OF sa COUNTY OF
The fo,r.�oing instrument was acknowledged efore me The forgoing instrument was acknowledged before me
this r qday of 20 by this__ day of, 20ffby
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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
(Signature of Notary Puorida) {Signature of No blit-State of Florida)
Commission No. ��° Stat�� N VAUGHN mmission No •io�AflYP6a, ` I
=a '� Como lorida-Notary Publ c -" ''State of F�N VA(/
mission #GG %'• �; Co orad _ GH
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REVIEWS FRON R LANS VEG E)At ion' xftAM VE
COUNTER REVIEW R EVIEW REVIEW 2, 2 22�ftLBII
DATE
RECEIVED
DATE
COMPLETED i
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