HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED
Date: 11 4// Permit Number:
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RIECEIVED
Building Permit Application NI O'V 10 (919'
Planning and Development Services ST.
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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 �VResidential
PERMIT TYPE: F eCh—I'C CZ_
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Address: ( 'Peo r) A r
Property Tax ID 3'9" 5- -,3,gq-oo3i-coo Lot No.
Site Plan Name: _T75 V,16c, e. 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: $ co Utilities: —Sewer —Septic Building Height:
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Name laixt '11 e (-k 141 0AY_j)0_, Name:
Address: 0- 120t) 1
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City: \,JLJOI-krI State: Address:
Zip Code: A514,cv Fax: City: J_-47_ Ige State:7r7—, —
Phone No. Zip Code: Fax: 77d-4&
E-Mail: Phone No 77,
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Fill In fee simple Title Holder on next page if different E-Mail low— mlu'
License 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 l 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."
�ig�nat_uir of Owner/Lessee/Contractor as Agent for Owner Signa u e f Contractor/License Holder
STATE OF FL RIQA STATE OF FLORIDA
'5-Y
COUNTY OF . 1.0cNp- COUNTY OF 6�
The forgoing instrumenj was acknowledged before me The for oing instrument was acknowledged before me
this 1`6 day of A\ 20 1� by this'day of iJo� 20� by
�Sa te.S Y^ �"'Sa-,.t 'S
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 Identificati n
Produce — Q 1, Produced �'L
Produced L
(Signature of Notary Public-State of Flor' GGA ,Sta 08h ve^�) '?
NP t► 2o(Si ature of No oAp � I
�PIRES:Decemberl
GOM elm Una putili°UnaeNlri`s
Commission No rma-�o'a.i :�:°� ,4Se I ptRESD�ryp�e�" mmission No. naeafi�No
REVIEWS FRONT G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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