HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: Permit NumberAccb, O J1ltlO
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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Site Plan Name:
Project Name:_
RECEIVED
Building Permit Application MAR 113 2020
Permitting Department
St. Lucie County
Commercial Residential
Additional workto be performed underthispermit— checkallthatapply:
_Mechanical _ Gas Tank —Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Tota q,�t oCOnstru •ion: ) q SgFt
ow L °Z[ Sq. Ft. of First Floor:
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osf'at_Gonstzuctlom: 6 0 Utilities: —Sewer _Septic
Lot No.
Block No.
_ Windows/Doors
Roof Pitch
Building Height:
NER/LESSEE:
CONTRACTOR:
Name 11
Name:
Address: D b 1=[N1 40Cf
Company:
City: n(Zf eiref2cL State: Ctr
Zip Code: 3f{ q rl Fax:
Phone No. 7D�
Address:
City: State:_
Zip Code: Fax:
Phone No
:
LFillfee simple Title Holder on next page (if different
he Owner listed above)
E-Mail
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.
UPPLEMEN A CO STRU
DESIGNER/ENGINEER:
Name:
10
_ Not Applicable
� TON:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: ' ' Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 c -
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, CONSUL:
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Sig ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1. "< dayof l�iY�O1�G`^1A j� . 20_c)D by
�'D n0YN1f�-�J W'iQ.
this day of , 20_ by
Nam f 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
( gna ure of Notary Pub' -State of Flori )
(Signature of Notary Public -State of Florida )
E
Commission No. M*."w:.'••- eJINAIS=2 ING
Commission No. (Seal)
MYCOMMISSION#GG276060
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20,2022
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'DATE
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DATE
COMPLETED
Rev. 2///19