HomeMy WebLinkAboutApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
3It -elm =
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Xx_-,y
PERMIT TYPE:
j-) .41 otj
Address: "--/ 76'
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Property Tax ID
();:2_ -
100 010 0
Lot No. �,4
Site Plan Name:
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luLo
Block No.
Project Name: PD o Pe,,u Y ,_i C _-i i
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Additional work to be performed under this permit — check all that apply:
" Mechanical — Gas Tank — Gas Piping ',,/ Shutters
""Electric k -'Plumbing _Sprinklers
Generator
Windows/Doors
V" Roof 6113— Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer V"Septic Building Height: 7 (D
WIN". S
Name c,, i 1,
Name
Address: 's hid
C"o m pa ny: A-�
City: -t— State: i�
Zip Code 'f--1 � Fax: 7 TQ, S5__
Phone N o. 172 ` A) - 7,i';),()
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Address:a (,�_5 t
City: State:
Zip Code:`,_VA' 4, Fax: 9" T_J_'-- 4J�i J
Phone No Ya - , -' 7T 61-D
E -Mail: 6--) ..........
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Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail=1-16in , s,
State or County License 4°23o�2_
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.
t1PL �i ENTA44 ST IJ T1 QR;LA NAA :!(� R ATI N:
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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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, wails, 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencine worK or recording vour Notice or
Signature of D*ner/ Lessee/ContMctor as Agent for Owner
FLORIDASTATE OF OF r D.
COUNTY O: r OF
The forgoing instrument was acknowledged before me
this 7 day of ✓" r t .20 Z61 by
ti
Name of person making statement
Personally Known ice' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida }
00 PRHONDA$ ROWE
Commission No.
REVIEWSPLANS
Rev. 8/2/17
The forgoing instrument was, acknowledged before me
this 17 day of V1 1 .20` by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
f� ++.
�l Yl 'i _ '�)tD l
(Signatu a of Notary Public- State of Florida }
0.AMMiqqiA19Mi04656 I Commission No
Expires May 19, 2021
Bonded Thru Budget Notary Services
_ RHONDA E
Commission GG 1 4656
Expires May 19, 2021
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