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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: )a 1G} _ Permit Nu s DEC --3 2019 Building Permit Application Planningand Development Services Permitting Department Building and Code Regulation Division St. LLICIe C:.`•I..II'lt;--Fl_ 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMITTYPE: OSED 1MPR MEMENT LOCATION: PRE�IP Address: !!�D-o —if, C)e C Property Tax ID#: 3�� [ — 00g 3 —too " Lot No. Site Plan Name: Black No. Project Name: =11E R§I« PTION OF WORK: �E p d�0��i 1✓fe�v(C W E in 2 �'Op� Ll 1 fa0 Bd(kftw, acAA ►L,kctka t, C©NSTRUCTI©N INFORMATION: W. 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: � �1� op Cost of Construction:$ 7_rIW Utilities: Sewer —Septic Building Height: OWNER/LBSSEE: CONTRACT©R: Name IA`\g 5&- Name: C EOdT6 it Address: �W ss (k(rgt'{p ort Company: Et C I City: Nt vie.<1E State:_ Address: Z(�o Y--- %445 } J"�1ro At E Zip Code: 3l &JO3 Fax: City:�O T 5\— State- Phone No. Zip Code:3!M"25 Fax: E-Mail: Phone No lq2— f44 47 Fill in fee simple Title Holder on next page (if different E-Mail -cool from the Owner listed above) State or County License t"�) %200 E(v 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. SUPPLEMENTAL CONSTRUCTION LIEN LAW INPORMATI(JN: 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 O AN ATTORNEY BEFORE RECORDING YOU_R NOTICE OF COMMENCEMENT." Signat le of 0 er/Lessee/Contra oras Agent for Owner Signatur of=RII)Aa�f- COUNTYCI ctor/License Holder STATE OF FLORID STATE OF WAC, COUNTY OF Theforgoing instru ent was a knowledged before me The forgoing instr ent was knowledged before me this,��' day of 20� by this c day of 20_ by Name of erson making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification/ Type of Id nti • tion Type of Idenific i Produced xis �— Produced 47 (Signature o oa Public-State of F or* (Signature of No - f,F Ld � - e. Commission No. °YPOe ' AUDREYB.HUMPHREY o<,p�?yam, AUDREYB.HUiv1PHREY s MYC ��SION#GG 34. 00817 Commission No. *: COMMISS16PP6G 300817 "• EXPIRES:March 6,2023 "' EXPIRES:March 6,2023 V oBaiidedThFuP : 1 7 F .•�C�: n �3`.'111C:1HZ y.y. _ '•,:SSSKlfY3La7�?RT:�.•1<.:%1 ...':,�:--rT 9YlT..' C ^'-iC.��,Y.-,•. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev. 2/7/19