HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
.......... ............
Building Permit Application FEB 2 0 2020
Planning and Development Services
Building and Code Regulation Division Permitting De,p81rtment
2300 Virginia Avenue,Fort Pierce FL 34982 St
Phone: (772)462-1553 Fax: (772)462-1578 Commercial esidtiniffi unty, FL
PERMITTYPE:
.PROPOSED IMPROVEMENT LOCATION:,
Address: 1290 061�&&-S 'ape-V6 34959
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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�.CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit-check all that apply:
440echanical —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:$ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name MIT6146( P AR-ftfA Name: -"Rle-IIAR Vo(-)4A9-T
Address: /0 q(2 me/56�-s �lwJ Company: il 0 LD 'R-G 1`4 6-1)Y f4/4_ I/u
City: ae-li-. State: Address: X:33 pJ-� 14,)tZ)ZQtJ 61-1 -
Zip Code: Fax: City: "?a/?-7-sl- we-J-L State: rL.
Phone No. S0, Roi°l A1133 Zip Code: Fax: X
E-Mail: (Il-fMA M C!C4 0- a C7 t, & CoM Phone No fMA pAb
Fill in fee simple Title Holder on next page(if different E-Mail 2V&4gA1z-5-2o13 QQMA1(- ,0-vM
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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SUPPLEMENTAL CONSTRUCTION LIEN ILAW INFORMATION:
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
Yfiff"OUR LENDER AN ATTORNEY BEFORE RECORDING TICE OFC M ENCEMENT."
Signa r Own r/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holde
STATE OF FLORIDA - STATE OF FLORIDA
c�(►,� -
COUNTY OF COUNTY OF -2
The forgoing instru nt was acknowledged before me The forgoing instrument was acknowledged before me
this day of V` 20 by thi�day o 20�by
g 1(''60 Y-/Jq n ) �'d r�'-+ tC i c,.)na a V (7 ) ip,
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
(Signature of Not Pub i - F (Signature of NotaryP blic-State of Florida)
Commission No. :3� +'•- AUDIWB.�IUMPHREY !<
MMISSI 300817 Commission No, DREYB.H
EXPIRES:March 6,2023 ��
=. .. ..,Q= t, MY COMMISSION 0 GG 300817
REVIEWS FRONT ZONING SUPERVISOR PLANS VE �OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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