HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZaSj Permit Number:? /
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Building Permit App icationMAR 18 2020
Planning and Development services Permitting Department
Building and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL34982 St. Lucie Co Ly, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE: EJq�)tk0v E
Address; 3�i cSL�A41 ��,�1 r �� .��iq$7
Property Tax ID #: I K4b 5 1 0 Lot No.
Site Plan Name: Block No.
Project Name:
J L E a2 s'E? R 77-A C fdE% j 'q sty M
Additional work to be performed under this permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
✓flectric w'Klumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ o;!� Utilities: —Sewer _Septic Building Height:
Name7'lrr�•! M`- %7AE,&1i Name: +G
Address:J-jQ(C��r+fie,r�fe� Ka,1 _ Company: wl`-
City: r&T R State: _rL Address: e
Zip Code: '34g5o Fax: City: - State
Phone No. Zip Code: 3�#50 Fax;
E-Mail: d1 Phone No� l - OT� /q��I
Fill in fee simple Title Holder on next p e (if different E-Mail 5 r -*
from the Owner listed above) State or County License - 17.57A3
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.
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in cc 1%ict 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
WITH YOUR LENDER OR A&ATTORNEY BEFORE RECORDING YOUR NOTICE EW COMM NCEMENT."
Signature of Ownr)ssee/Co tractor'as Agent for Owner "Sig ature of Contrac --� icens Hol erSTATE
OF FLO STATE OF FLORID
COUNTY OF ' �s� l ni COUNTY OF
The forgoing instrument waslllacknowleciggyY��dl�,,b.,efore me The folgoing instrument was ac mcwledged before me
this day of d77.19 ,�/� ZO�I/by this /- day of 2q-A -by
—ri r,)e-efwen � ���;,� Yne Ewen,
Name bf persorlmaking st ment. Name of person makin statement.
� ent.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of I7o - (Signature of Notar ublic- State of Florida )
AUDREYB.NUMPHR r...,,, —
Commission No MMISSI(MYd16300817 Commissio [ " •. AUDREYB.HUMPH(S'al)
'•..NFRONT
PIRES: March6,2023 '.• ;.: COMMISSION0GG3009.
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