HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CC.., ..ETED FOR APPLICATION TO BE ACCEPT 11
Date:xA,xm Permit Number: i
Building Permit Applicatio
Planning and Development Services MAR 0 4 2020
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Si. Lucie unty, Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address:
verL
Property Tax ID#: 45-09 - 13o" 0010
Site Plan Name:.
Lot No.
Block No.
Additional work to be performed under this permit- check all that apply: '�)Ojx' re .(C5
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
NE/LESSEE;
G • NT G
Name P-o IRIII?rName:
Addre s: 13 S n14yec&Company:
City:'k"Seh heack State: RI
Zip Code: 3 Fax:
Phone No. Z' �� i $
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Address: Ig))_r6�.0we-
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Zip Code:
Phone No
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State: rL-.
Fax:���� - 9L I
E-Mail: YIGk@ tr Cd r f4L, Cper
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
Co"
State or County License M.074M
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.
DESIGN ENGINEER: —Not Ap licable
Name: I, 6 1H?ZY ✓
MORTG GE COMPANY: _ Not Applicable
Name: Q
Addre 0Yg
Addr s:
P(v5 IJ .
City: D I-1 State:
Zip: Phone — S—
City: tate:
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
WF#i YOUR LENDER OR AN ATTORNEY BEFORE RECO INGAYOUR NOTICE OF COMMENCEMENT."
SignIre'of Owner/ Lessee/Contractor as Agent for Owner
Sig a u e of Contractor/License Holder
STAOF FLORIDA' 1
COUNTY OF Sri • Luc, a
STAT OF FLORIDA
COUNTY OF %4 . L,ycrr IF
The for oing instru nt w acknowledged before me
this I dayof W12�c� •20AQby
The forgoing instru nt s acknowledged before me
thi) day of 20jV by
s
741
Name of person making st ment.
Personally Known OR Produced Identification
Name of person making st ment.
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature ota of Florida)
(Signature of ottaary^ of Florida )
(6Pyubliicc-State
Commission No.G&11ai7// =�i ;Notary Public eooT
i• •; Commission N
qub�litcc--State
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REVIEWS
FRONT
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REVIEW
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REVIEW
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RECEIVED DATE'
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