HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
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NOV -12019
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Building Permit A lic �� r�iittin Department
partment
Planning and Development Services St. LUde 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:
Address: 4101 P—a- ✓A Dve-,
Property Tax ID#: 6y0--5 – S® ` – O 1 y S Oa a Lot No.'5.1-PAA
Site Plan Name: Block No. �0
Project Name:
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DE7AlLED}DESCF�IP�T.IONOF WORI( i ,
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CONSTRUCTION INFORMAL-ION: ° ^ r
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Additional work to be performed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _ShuttersWindows/Doors
_Electric _Plumbing _Sprinklers _Generator V/_Roof q' 12 Pitch
Total Sq. Ft of Construction: 3460 Sq. Ft.of First Floor:
Cost of Construction:$ 13, °{ Utilities: —Sewer —Septic Building Height:
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OUVNS'EE .. ; , i�Y rg[a r s,s�Hca t ?i s; a,r� tCONTRAC#l'OR Y I .� �� . �t ,, F, a;g: + saxa �, ; .
ar ;err'S -i'� i�,i t�i;.•�r�`a� _ ;�! :t + r,::�.>T .:F'�,4 ��a�r� �r+" �.
Name �� Name: SSS J2mitK4�7%'G^s gdL� vN-S
Address: �J07 > A moi'-- Company� c Ayr )",J
City: FDgxx ' State: L Address: 2!G o, A&yzJ--"'A1 AVe
Zip Code: ?�Acj&a Fax: City: Q2,LA^.r State: �-
Phone No. !)')),• Zip Code: --,?P465' Fax:61 Ole-64?)�
E-Mail: v_ e""a"n Phone No 4,ye) `S(e–O�'�
Fill in fee simple Title Holder on next page(if different E-Mail ba rcc o��,� �sS7lo� dl�-• [v�
from the Owner listed above) State or County License (fC(_l3L t;V39
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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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name; �
Address: Address ' t3 0o ua
City: State, City: fl State:� --
Zip: Phone Zip: a�-l _Phone: fie,
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 IMPROYEMENTS 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."
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Signature of Owner/Lessee/Contractor as A ent for Owner Signature of Co a or icense Holder
STATE OF FLO DA STATE OF FLORIDA.
COUNTY 1 .HCl G COUNTY OF rd naa5e
The forgoing instr ment was acknowledged before me The forgoing instrumentwas acknowledged before me
this+ day of� 20.A by this M day of L�' Pr 20 j by Ao&rh 6
Name of person making statement. Name of person making statement.
Personally Known �_OR Produced Identification Personally Known 0R Produced e '
Type of Identification Type of Identification
ProducedProduced SCOTT MEDLIN
COMMISSION 9 CG2949
ASE FMIM:June I5,2020
? J1/WV�NW4
(Signature tart'Public-State&f Florida} (Signature of Notary Public-State of Florida}
d{�` P.&,kE, MARYTHOMPSON
Commission Na. a * gal)Conxnuel0n#Ga3 BCommission No. (Seal)
Expires May 10,2023
N��'aF�t.��� eond♦d7lruBuepsitbtaq
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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