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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED q Date: �d \ay \`� Permit Number: 1��d Jdss 1 RECEIVE® 69 OCT 2 4' �of3 Building Permit Applicati n Planning and Development5ervices 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 _X PERMITTYPE: PROPOSED IMPROVEMENT LOCATION:. Address: D `GBGL� ,.e Property Tax ID#: 3� d D? 36- ©00- 6 Lot No. Site Plan Name: // Block No. Project Name: Cl ,'A (froy"`f- DETAILED DESCRIPTION OF WORK: c? rna A V Iv �f R d clf- de-da / " 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: 6Do Sq. Ft.of First Floor: Cost of Construction: $ (0/6'00 Utilities: —Sewer —Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name 0 c vl) Name: �2 Address: ' oct - Company: tO r 7 City: (L 6'errGr_ State: I- Address: W (610-424c "ST Zip Code:?��1 7 Fax: City: on ff-ST L-ua P State: F(-- Phone LPhone No., Zip Code: �qq C 7 Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail 6 ?oo-Co­*�,I from the Owner listed above) State or County License CL 3//7t 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. SUPPLEMENTAL CONSTRUCTION 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, 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signature of O ntractor as Agent for Owner Signature of Cont se Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF SE 1.t,C,\-Q__ COUNTY OF�aA uCi- The forgoing instrument was acknowledged before me The fo^roing instrument was acknowledged before me this_R day of ('�?+ ,20 (c) by this faday of C)CA ,20LS by 2141 ,4AS (0A,01A Name of person making statement. Name of person making stat ment. Personally Known 1✓ OR Produced Identification Personally Known L""' OR Produced Identification Type of Identification Type of Identification Produced Produced 'Aq0JA I a ( ignature o ary Public-State of Florida) ( ignature of Phry Public-State of Florida) pY-MOOR1. Commission No. .Notary Public-State of Florida BRANDY MOORE 39 '��. MY Commi slop Expires • Commiss on#GG 102839 REV]E �,, ;t ° FRON1Mey 9 SUPERVISOR PLANS Alb4Qloom t P11 LEs MANGROVE REVIEW REVIEW �''p M 0 REVIEW DATE RECEIVED DATE COMPLETED Rev.