HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /q)
Date: �� Permit Number: J
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Building Permit App icatiort!CT 7 2019
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie C® nt r FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT TYPE: CKan
Address: Y130 Inn-)o5nn Pc;in ' E / -I -5�• Lo Jq
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
~CSR PT �F O
SElE'l- L `,X �w
Additional work to be performed under this permit–check all that apply:
' , echanical _Gas Tank —Gas Piping _Shutters'.
hutters _Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer Septic Building•.Height:
� CC1 •AC O' :
Name V_ ►1 �. Name: Lot,5 47• �JO� )NI C r
Address: 1�1'i Company:LUiG") . 'L `j2V�II C-�S
City:Po r-a- 5ar ri- -- State: FL_ Address:._`, Iy 5W :.,.M C Ira-.C-Vt n 4v-e__
Zip Code: 3 C/.QZ.o. Fax:, City:Qb�k.'• aryl '. L:UC�.e: State:
Phone No..: Zip Code; y.:a.S.3 Fax:
E-Mail: Phone No u- 39- ZeTq
Fill in fee simple Title Holder on next page( if different E-Mail LueVQ(C1f_5 ,� �• C n
from the Owner listed above) State or County License F (.
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. 1
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 AFFIDAVIT: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 IMPROVEMENTR TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE OB SITE EFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAI FINANCING, CONSULT
WITH YOUR LE OR A14 A ORNEY BEFORE RECORDI YOUR NOTICE OF MENC ENT."
Signature of Owner/Lessee/Contractor as Agent for Ozzwn AWer Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instru�ent was acknowledged before me The forgoing instru ent was acknowledge before me
this y day of ��� 20 by this day of 20Z"L by
T U A 02 ,L4& _�3 c�G ) V -09�p
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 Identific�a on p'
Produced Produced
(Signature of of Public-State o (Signatuee of Notary Public tate of Florida)
Commission No. ;=ot,�,YP° AUDREY B.HUMPHREY
my OMMISS09#I0G30,0817 Commission o.• a PU•.. B.HUMP
EXPIRES:March 6,2023 =
<: MY COMMISSION#GG 300817
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REVIEWS FRONT ZONING SUPERVISOR PLANS Bonded hru Notary Public UndetersNGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED. -
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