HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Numbe- ro';
Date:
TT I
Building Permit Applic tion
MAR 1 7 2020
Planning and Development Services Pe rm,i tti fig e a 7-m e n t
Building and Code Regulation Division St, Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982 Commercial Residential
Phone: (772)462-1553 Fax: (772)462-1578
PERMITTYPE
PROPC►SEDIM., T
PR VEMEN LOCATION`
Address:
Property Tax lD#: J-1502.- '76,2- -0031 Al Lot No.
Site Plan Name: Block No.
Project Name:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
—Mechanical —Gas Tank Gas Piping —Shutters Windows/Doors
_XElectric —Plumbing Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ YO-0 Utilities: —Sewer Septic Building Height:
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,C0NTRACT
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Name:
Address: QQ&3 4 Company:
City: I a —� �J k&D-r-A State:.7�- Address:
Zip Code: 4 96 7' Fax: City: State:,
Phone No. Zip Code: ,3 1/Nwu__�_ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail
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.
S( rPP.EMENT I CI( N 7N 1��101 �.1 U Wffi R /1
10 ,N
a ,20
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 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 MUST BE RECORDED AND
POSTED ON THE JOB BEFORE THE FIRST INSPECTION. IF YOU INTEND TO TAIN FINANCING, CONSULT
WITH YOUR LENDER O AN ATTORNEY BEFORE RECORDING YOJJR NOTICE OFC NCEMENT."
C�
signgtLkLycTf Owner/Le a/Contractor as Agent for Owner sFgrffiture of Contra cto cense Holder
STATE OF FLORIDA STATE OF FLORI PI
COUNTY OF SL 14-ml e. COUNTY OF d Lei1?,
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this day of �C,� 201pby this -day of i_/�c"CJA 202_0 by
Yom. a ✓r
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
n(o
(Signature of Notary Public-Sf ate of Florida jV.. David RWnon nature of Notary Public-State of Flori D ue
NOTARY PUB IC , NOTARY PUB
Commission No.�$G(0705O2 STATEOFFL mission No. C ��" -+Comm#G1STATE OF 2 DA
Comm#GG28 52 y q10 C feS 1G/28 2 23
-."e I.". Expires 114AM2023
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
CO2/7/19
MPLETED
Rev.