HomeMy WebLinkAboutBuilding Permit Application All APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
qDate: Permit Number. , ,
R6 CE-IV
Building Permit Applicata n
Planning and Development Services NOV 0 6 2019
Building and Code Regulation Division ST. Lucie Coun
2300 Virginia Avenue,Fort Pierce FL 34982 tX, mltting
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT TYPE:
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Address: /?S–.:20 tD C A:� X5'2- X"a YaL. 3 4�y_ffl j
Property Tax l D#:_�` l/-- �l/ Q( -► Chl D/�"" Lot No.
Site Plan Name:__,4:ZYpp'Ag Block No.CF_ ?S'"
Project Name:
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Additional work to be performed under this permit–check all that apply.
—Mechanical _„Gas Tank �Gas Piping �Shutters A Windows/Doors
—Electric _„Plumbing Sprinklers ! Generator _Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor
Cost of Construction:$ .r. 4r68' Utilities: —Sewer —Septic Building Height.
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Name: C-CL
Company; 4s– O';CQA9W/ 4 n .aA.R-P
State:.,, Address: YQ1 dxg? PtX1,4 tbS
Zip Code: Fax: _ City:_ ?`u,y1 JnC_A State
Phone No, �F Zip Code: 3SUf Fax:
E-Mail; r'� C�/�' /P�/� G'.4%i11- G' Phone No 3 7 1 l a0
Fill in fee simple Title Holder on next page(if different E-MailA n a AW A1401_i ig– Tn
from the Owner listed above) State or County LicenseZ4 Q,t.J� ,,2s
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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DESiGNERIENGINEER: 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 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 ATUDMEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Les a/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTYOF 41 a ib- COUNTY OFM '1 Jn
The forgoing instrument as acknowledge before me The forgoing instrument as acknowledged efore me
this�day of�J(_ 20 jq by this 3A day of� '20 R by
Name of person making statement. ame of person making statement.
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Personally Known_ OR Produced Identificatio J R f. 2 ersonally Known OR Produced Identific n ~ '"
Type of Identificatio W 2 W� ype of Identificatio i5 K o
Produced
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nature of Notary Public State of Florida) 4 (Sign ure of NotaryPublic-State of Florida) a
Commission No. 0Q) {Seal) y C mission No. j�V (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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