HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /n�
Date: /!� Permit Number: I lo -® :SIRECEIVeb
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Building Permit Applicatio zo19
Planning and Development Services ST. Lucie County,
Building and Code Regulation Division ty' Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPQSED.IIVIPROVf IVIENTiOCATION
Address:
Property Tax ID#: /3-0 7- 76;? . doao - d 00 --6-- Lot No.
Site Plan Name: Block No.
Project Name: ,r2
DETAILED DESCRIPTION OF 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 _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ /,9019. D D Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE` "' _ CONTRACTOR
Name Name:
Address: D Company:
City: '� State:_ Address:
Zip Code: 3 qg,,5-/ Fax: Cityp.�c.� State
Phone No. Zip Code: 3 ygy3 Fax:
E-Mail: Phone No '/6/. a7 77
Fill in fee simple Title Holder on next page(if different E-Mail/4;99 ro_
from the Owner listed above) State or County License �� /.3�(�^„ �� 9
SLC
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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.
�SUPPLEM�f�T�L�C~DNSTRUCTIDN ����.L.�!►W�1NF�0<RIVIATf�N ����� �� ���� � ����
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: —Afiot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made-t%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
POSTED ON THE JOB:ffEIPEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER Q AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMME NT."
Sign r o caner/Le a/Contractor as Agent for Owner Sign atu gofyContractor/Licens Holder
STATE OF FLORI ) STATE OF FLORIDA
COUNTY OF r!,(/el 2_ COUNTY OF �� , -1 Q.
The forgoing instru en w s acknowledged before me The forgging instru en w s acknowledged before me
this f Nay of 20�"�by this /� ay of 20 by
W C�w k - ()V\I
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Name of person making statement. Name of person making statement.
Personally Known Ll OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
P
wed Proddced
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(Signature of Notary Public-State of Flori David Raymond gnature of Notary Public-State of Florida)
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NOT PUB C C David Raymond
Commission No. U _STATE OFFLr
mission No. tJ LS--2 o INOTARYPUBLIC
Comm#GG2s STATE OF FLORI
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE lVl'A� �Wt 3
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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