HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IZ. 1 �Jcl Permit Number:
030 a �:���� RECEIVED
• DEC 17 20;9
Building Permit Application
Planning and Development Services 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 Residential
PERMITTYPE: c—
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Address: Goog 51 LUEgg OAK DOY5 Fnl;zr Pt,oe9�—,F"L.
Property Tax ID#: 34cl2.,- 607-0120-QDd -3 Lot No.33'' 34
Site Plan Name: Block No.
Project Name: DiXE r)EN(:E:
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Additional work to be performed under this permit–check all that apply:
XMechanical _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:$ d •d a Utilities: —Sewer —Septic Building Height:
Name Name:
Address: Compa •
City: State. Addres . G
Zip Code: aux::, City: Stat
Phone No�, J Zip Code: _ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mai r 'C
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:�T City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: ZNot Applicable BONDING COMPANY: LNot 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 thepermit 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 UST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRSTINSPECTION. IF YOU INTEND TO T IN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUJI NOTICE OF CO M CEME T."
Signat of Owner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder
Nr
STATE OF FLORIDA STATE OF
COUNTYOFT. LUK CCOUNTY OF0WLUCIE
The f1or oing insfr ent was acknowledged before me The for oing instrument was acknowledged before me
this L_15 day of 1LMMEM,2013 by this day of D97C5N¢F,20 IQ by
T NAES STE-VIE 5SNDDR5
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification- Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced F 51 D220-452-42-053-0 Produced
(SignkuLPA aory Public-State of Florida) (Signatu of ary P blit-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
aW 044.
Notary Public Stato of Florida
TimoRty Poulos
, ' Nofary Public Stale of Florida My Commis m GG 200027
! IN Timothy Poulos 04 Expires 04/11/2022
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