HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
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Date:1� LtJ � Permit Number:
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Building Perm it.Applicatio2Q19
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Planning and Development Services St' tuc,�,Coart, e
Building and Code Regulation Division unly nt
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residentia
PERMIT TYPE: -�
"PROPOSED,4tNPROVEMENT,,LO- TION
Address:
Property Tax ID#: �.�-1 1 `C� Z— � CDC-' Lot No.
Project Name:
DETAILEDTkQESCRIPTIO1VuwOF`WORK J
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CONSTRUCTION INFORMATION 3 »s,
Utilities: _Sewer _Septic Sq.Ft.of First Floor:
Cost of Construction:$,,�� Total Sq.Ft of Construction:
777,
TFLOODPLAIN,DEVELOPMENT PERMIT'for structures exempt'from BulldingCode that are in the 4
�..T, .
floodplain.
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Nonresiden"tial'Farm Bui�ding:� 4 Temp Bldg:/Shed used^exclusively�f r.constructi in
1Moblle/Motl61ar for temp construction office Bldg mvolved-ln distrlb.'of electriclt
Other. Flo�one: �' , BFE Floodway?Y%N If ."
No Rise Cetti icate with supporting=data-attached?mY/N
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a`All Other applicable state,and federal,permits shall be obtained prior to,commencemEnt,of.
construction: „ .
OWNER/Lt SEE: f T CONTRACTOR:
Name 1 J• f✓c CJ Name:
AddressV-c� Company: Cmc —Q��
City: l/A- Stater Address lZC� n�7 C_d�
Zip Code: �C'1 \ Fax: City: ��_-CL C-L-V— State:-T--k
Phone No Z��- �• �L � Zip code AX Fax:
E-Mail: Phone No--n1—• qn
Fill in fee simple Title Holder on next page(if different E-Mail' o_-Ir "Ji LLZC#1 L�•LC n
from the Owner listed above) State or Getnty L" ense
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required. II
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SUPPLEMENTAL�`CONSTRUCTION ,LIEN LAW INFORMATION .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Z' Phone:
FEE SIMPLE TITLE HOLDER: _Not Icable 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 jobsite'
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commenctf work or recordin our otice of Commencement:- _—
9Sig_n-aTLure of Own /Lessee/Contractor as Agent for Owner Signature o -Contractor/License Holder
STATE OF FLORIDA r STATE OF FLORIDA
COUNTY OF COUNTY OF n
The folgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisday ofbg C�,20G�by this day of 2 20�by
MA fl n ��(� � u� 1�Cux
Name of person making statement. Name of person making statement.
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Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification -J
Produced `_ Produced �f -
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(Signatur (Signature \\a a,
,o;;��d�a, ELLEN VAUGHN ELLEN V
°tom G =State of Florida No GHN
Commissi _°o =State of Florida-NotfSig Pblic Commissi __
�6eA(�blic
=y �; n #GG 270079 �- on #GG 270079
oQP.' My Commission Ex fres %n,;����°��� My Commission Expires
14, XV22
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REVIEWS FRONT ZONING' ERVISOR PLANS VEGETATION SEAT GROVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.1/9/2019
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