HomeMy WebLinkAbout20200331_Building Permit Application_001All APPIICABIE INF٥ MUST BE CoMPLETED F٥R APPLICATioN T٥ BE ACCEPTED
Date:Permit Num ber:
ص١ -٠ لآCOUNTYدо1 ٠ A.'
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FI 3Α982
Phone; (772) 462-1553 Fax: (772) 462-1578 Commercia!Residential
PERMIT TYPEi
PR٥P٥SED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: MMaa · ζ 02 · C>Oa3>~O00 ‘ á
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lot No. لله
Block No.Site Plan Name:
Project Name: -
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
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Additional work to be performed under tills permit - clieck all that apply:
— Gas Piping
— Sprinklers
Mechanical Gas Tank Shutte
Electric Plumbing Genera
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Windows/Doorsrs
Rooftor Piteli
Total Sq. Ft of Construction:Sq. Ft. of First Floor:
Utilities; —Sewer —Septic Building Height:
ooCost of Construction: $ Ъ/П1 5)
OWNER/IESSEE:
Name !<ا!\/أ^ JZAddre-
City: دثجيجصكZip Code: ỊC\qo4
Phone No.
E-Mail:
-
Fax:
-
CONTRACTOR:
-
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Zip c-
Phone^OiZ::7§; Wb ¡ I 4ο
State or County Licens^^ç. I ؟ ٩لآ
Name:
Company
Address:
State: řl
Fax:
State:
-
Fill in fe-Aادا
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.
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SUPPLEMENTAL CONSTRUCTION UEN LAW!NFORMAT!٥N:
/Not ApplicableDESIGNER/ENGINEER:
Name^
Address:
City:
^Not App!!cab!6 MGRTGAGECGMPANY:
Name:
Address:
City:State:State:
Zip:Phone Phone:Zip:
FEE SIMPLE TITLE HGIDER:
Name:
Address:
Not Applicable .Not ApplicableBUNDING COMPANY:
Name:
Address:
City:City:.
Zip:Phone:Phone:Zip:
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[ rnakes no representation thaUs gran^ng a permit will a^؟or¡ze the^ermit holde؛to build the subject structurewhich is in_؟on۵¡ct with.any applicab.le Horne Owners As.socاation .rules, bylaws pr and covenants that may restrict or prohibit suchstructure. Please consult With'your Home Owners Association and review your deed for any restrictions Which may a^ply.
In consideration of the granting of this requested permit, I do hereby agree that I will, inali 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-residentla l use
WARNING TO OWNER: YOUR FAILURE TO RECORD
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 AnORNEY BEFORE RECORDING
NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
UR NOTICE OF COMMENCEMENT.
fSignature of Owner/ Lessee/Contractor as Agent for Owner Sig latUre of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUN^OF
The forgoing Instrument was ack^Tồvyl^ged before meday 0(لآthis
The forgoing instrument was acknowledged before me
day ofthis 2٥ by
Name of person making statement.Name of person maklng^atement.
Personally Known _
Type of Identification
Produced
OR Produced Identification Person^wn _O^roduced Identification'
(Signature of Notary Public- State of Florida )(Signature of Notery Public state of Florida )
Commission No.(Seal)(Seal)Commission No.
REVIEWS 'ZONING
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FRONT
COUNTER
SUPERVISOR
INIVINN
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DATE
RECEIVED
DATE
COMPLETED
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State .f Florida Acknowledgement Notar٧ Certificate1ไ;ๅ
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STATE ٥F FL٥R!DA
C٥UNTY٥F ١1ع٠-ه;م١ا 1ọ\ựự٩وس3ไ^๙ before me who proved to
dence to be the person(s) whose name(s) !s/are subscribed to the attached؛me on the basis of sat!sfactory ev
ทstrนmeทt and acknow!edged to me ttiat that he/she/they executed the same !n ا[[name of document
h!5/her/the!r authorized capac!ty(les), and that by h!s/her/the!r s!gnature(s) on the !nstrument the person(s) or
٥F PERJURY cert!fy under PENALTY ا.ty upon beha!f of wh!ch the person(s) acted executed the !nstrument؛ent
sted above that ttie forego!ng paragraph is true and correct. W!TNESS my hand and ااunder the !aws of the State
,official seal
, a notary public, personally appeared by physical presence.On
Personally ki OR
Produced identification Type of identification produced:
[Signature o] notary public]
My commission expires:- / Lf. 2ơ2 Ì
»MARGARET L. TIERNEY
Notan, Public, state of Florida
Commission# GG 140124
My comm, expires Sept. 16,2021
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Official Seal
3 ٥٢ ؤ
05-74-0433NSB 02-2020