HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: s��` �� Permit Number: ;")n
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EIBuilding Permit AppliPlanning and Development ServicesBuilding and Code Regulation Division 2300VirginiaAvenue, Fort Pierce FL 34982 tment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial FL
PERMITTYPE:
PRaPOSEQ INtPRVVEWRN, IN ATIO
Address: I -) O AW D Ar t —1 � -.
Property Tax ID #: Lot No.
Site Plan Name: ��C L�%VL� )�O�•�f Block No.
Project Name: �}�
CONSTRU I019,4C,NFORMIkT ON:
Additional work to be performed under this permit —check all that apply:
_Mechanical
Electric
_ Gas -Tank ' _ Gas Piping _ Shutters _ Windows/Doors
_ Plumbing _ Sprinklers _ Generator _ Roof . Pitch
Total Sq. Ft of Construction: /
Cost of Construction: $ a ,27j
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
QWNER/LESSEE:
CONTRACTOR:
Name'Z
Name:
Address:
Company: i � b �
City: ;' �ri�l =, State: :�
Address,/%%�
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Zip Code:�T: ,, �..::±r:'.;1 ;r� Fax
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City: ::; J'F� ' 1`$tate:19
Phone
Zip Code. Fax:
E-Mail: _ ._ �,._ .:,-.
PhoneN6_ 77
Fill in fee simple Title Holder on next page ( if different
E-Mail Kb�ll '77121—X'5AJ"l� �
State or County License
from the Owner listed above)
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.
ER,MENTAL CM 11111 t@N [REWN UN, FOR,AOTI I
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sign a Owner/ Less e/C ractor as Agent for Owner
Sign atur ontractor/Licenses o er
STATE OF FLORIDk, 7
STATE OF FLORIDA
U4.
COUNTY OF �
COUNTY OF
The forgoing instru ent was acknowledged before me
The forgoing instrum t was acknowledged before me
this, to d.ay of �e cb 2c ��y
this �tiay of 2�by
jv %w � h
!4 .�o , rn
n U _10 Yi,\ (r) -
Name of pers n making statement.
Name of person miAing statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No Public- State of Florida
(Signature of Nota Public- State of Florida )
,' AUDREYB. REY
Commission No. ;?•"' �:b's
...•..,,,.
Commission No .••.<�•• .; AUDREYB.H
SSI 300817
,*c SStON� 17
EXPIRES: March 6, 2023
= : ��' EXPIRES: March 6, 2023
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REVIEWS _ FRONT
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PLANS
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.2/7/19