HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i Date:_�Q1 Iuk Permit Number.
RECEIVE®
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Building Permit Applicatao i OCT
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax; (772)462-1578 Commercial Residential
PERMIT TYPE: ct��
PROPOSED IMPROVEMENT LOCATION
Address: 4 6A JJ9,
Property Tax ID#: 3 - ® ' 019.14. Lot No.��
Site Plan Name: Block No.
Project Name: 6 � faw mqiA KPA—
DETAILED DESCRIPTIONOF'WORK
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CONSTRUCTION INFORM'ATM-,
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:$ Utilities: _Sewer _Septic Building Height:
"OWNER/LES- EE: CONTRACTOR: �Lp1��/ 1+2a�ol D..
_ _ s.
Name W tAM Name: iiz
Address: Sf�L� ��-cfv� �+-� Company: eee7n_ C- --e- S'
City: State: Address: SUIP �:DiLC�N 1
Zip Code: 3 49$ Fax: City: (-A 16t- "Cl! State: I;
Phone No. Zip Code: `gn 6 �_ Fax: r
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E-Mail: Phone No
Fill in fee simple Title Holder on next page 4 if different E-Mail )5af l-r'i/cc,j�,.}�XAsC_ a A-VT- It 9j
from the Owner listed above) State or County License
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required,
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SUPPLEMENTAL CONSTRU.CTI.ON,�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,
'i 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 IIID YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SI FORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OF-AN ATTORiRY BEFORE RECO RDI NOTICE COMMENCEMENT."
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Signatu e o w r .Lesse /Contfor as Agent for Owner Signature of C actor/License Holder
STATE OF ORIDA STATE OF
FLORIDAF5 . �. \ SC .
I-\) eCOUNTY OF
The forgoing instrument was acknowledgediefore me The forgoing instrument was acknowledg before me
this\day of_ �� 20\ by this'% day of 20 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 Identifi ation
Produced V61--6 L Produced— �-
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NEN1
NAM�IEGSo23 4�.
(Signature of Notary Nblic-St SNA #GG022 3(Si^ ature of Nota } i to
••'i�va"'+�,..., COMMISSION =16.2 ''i :: EyPIRES: Pbb Underv+dlc�s y:
Commission No ��' (5 1 ESDoom Unde en 4 ed
�;+_ R public „ission No gond
dmNNoletY '•EO@�`••
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REVIEWS FRONTZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW I
DATE
RECEIVED
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COMPLETED
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