HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:, I 0 Permit Numt e 1'
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7KD
:, _ OCT 3 2019
BuildingPermit A liCmittin
pp g Department
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
'PRQPOSED I"MPROVEMENT LOCATION¢ I
. _ y.
Address: 7505
Property Tax ID#: I 1-' `'-0 -Z Lot No.
Site Plan Name: Block No.
Project Name: KI {/
DETAILED DESCRIPTION F WORK
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator XRoof Pitch
Total Sq. Ft of Construction: (0SD Sq. Ft.of First Floor:
Cost of Construction: ZEZ Utilities: —Sewer —Septic Building Height:
QWNER/LESSI*E. CONTRACTaR:
Name Name: MaKictV
Address: S ok to Company: e
City. State:_ Address:
Zip Code: s Fax: City:"300Q',2r1cm Stater
Phone No. Zip Code: 32J Fax:
E-Mail: Phone No 12�
Fill in fee simple Title Holder on next page(if different E-Mail h If1 %M
from the Owner listed above) State or County License
J L122-8
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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SUPPLEMENTAL CQNSTFtUCT10N LIEN LAW 1W"RMATION `
•DESIGN ER/ENGINEER: � _Not Applicable
. . .. ... ...
le 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
"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
POS ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WIT UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee Contractor as Agent for Owner SignatifreSf Cont for/License Holder
STATE OF FLORIDX STATE OF FLORIDA - ,p
COUNTY OF IAIA ltil , U COUNTY OF �Ibian �AVe— l'
The forgp ing instrument was acknowledged before me The for ng instru wa acknowledged before me
this ' cf day of,{ !; c eY ,20M by this'l y of f 20a by
&ll'a, Qct!KlA 67-et<-ey
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
fpr"�my. Notary Public State t Florl
Leah Denise Ball
COMMISSlon GG
(Signa ure o Notary Public-State o ( ' t e of Notati6lic+-,eta
�Po a o a tete of Florida
�?�4
Leah Denise Batl
Commission No. (Seal) Commission No. + ' .'i3. My 036768
Commi
Expims+0l 612;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.