HomeMy WebLinkAboutBuilding Permit Application 1 All APPLICABL INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/1q Permit Number:
RECEIVED
W...__-..,........._.........-._.._ -- Building Permit Ap pl i catio
Planning and Development Services NOV 18 2919
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie C unty, Permitting
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: LI Ee-I-PZICA L u {
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Property Tax ID#: �aJ3: 9 Lot No.
Site Plan Name: Block No.
Project Name:
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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: $J pUO, d Utilities: —Sewer _Septic Building Height:
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Name flop LL Name:
Address: lo 50 Company: H ai. 0. Uedne-cd
City: (r State-NY Address: / In
Zip Code: 160.fo- ' ax: City: R. Joerc'Q--'� I State:
Phone No. Zip Code: 3L499C) - Fax, -
E-Mail: Phone No , I
Fill in fee simple Title Holder on next page (if different E-Mail –4{�Lt,t'usS a Q cl 0–o m
from the Owner listed above) State or County License
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:
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."
Sig nat re f Owner/Lessee/Co tractor as Agent for Owner Signat e o Contractor/License Holder
STATE OFLORIDA STATE OF FLORIDA
COUNTY OF S�. Lyc`e COUNTY OF 'S�• Lu���
The fo going instrum en�was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of �1d 20_11 by this day of 00� 20_ft 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 Identification
Produced Produced V iQ L
llprE a
tVcNS
(Signature of Notar ublic-State of Florida ) s (Signature of N -2;. S i %givig81[4fS#)GGo2 62z I;
mss' •�'= PIKES:December 16,20t0
►E ESS - �- l d2n,titar>!:
Commission No. Crda-�as pM GN p�zU23 Commission No. ,r....• °� adThruNotary� 1��
,q :°U9 r,•: MY COMM D`�mber 16 ?6writa.
Notary
REVIEWS FRON `-;;; ; NI tKVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R-e—v. 2/7/19