HomeMy WebLinkAboutBuilding Permit ApplicationAll AP . L CABLE INFO MUST BE COM�tti ED FOR APPLICATION TO BE ACCEPTED 'L I /�
ate: \ Permit Number: Cot - t yox
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--_-- Building Permit Application,,,
Planning and Development Se icesiti?lcg !
Bdilding and Code Regulation�, iv)sion
2360 Virginia Avenue, Fort Pler FL 34982
Phone: (772) 462-1553/Fa772) 462-1578 Commercial Residential
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PROPOSED -IMPROVEMENT LOCATION:
Address:V161-1 WoVcr Cirardc/1 Parkwc�� ,PQf+ 5V. CL�c-(c
PropertyTaxlD#: )361-G,05-O3G3-000-Co Lot No.
Site Plan Name: Block No. Jr IJ
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: SBO• no Sq. Ft. of First Floor: I i OG
Cost of Construction: $ 1 %, 000 Utilities: —Sewer _Septic Building Height: IL')
OWNER/LESSEE:
CONTRACTOR:
Name SwiFi 11ornc6Ltycrs of
Name: MiaCLCI 1�5rocJD
Address:5(ol NJW Lakc WPWI`r)-C�/
191• 0010
Company: Rfooic- rc�
G LC
city: Tbi-- Sf: Luci a
Zip Code:�Fax:
Phone,Noa+J L/-70 C,- 30b (r-N
State: FL
ACns+ru'On
Address: g731 )A ttf6oil•c
AVc pj-Zt3
City:-DCtrc•i -F�CcLck
Zip Code: 331111"S Fax:-
Phone No 6G I -ZlqC(- i ZZ
State:IPL
E-Mailickr-J4Q.Swi* llcac bw crS FL .CoPY
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail M ILC li Lroi c CanS�fox�an
FL • caM
State or County License CRC- 133
Z7-05
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.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION: "
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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
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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COM ENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR DA
COUNTY r /-UG�-e
STATE OF FLORID
LUC( e
OF CAI
COUNTY OF 1(�t
The forgoing instrument was acknowledged before me
The forgg,oing instrument was acknowledged before me
this IT day of JCcnuG.f't4 ,20ZUby
this (dayof 20 ZGby
fVliGhat�l "�I�ar�r,
� I'-ewn
Name of person making/statement.
Name of person making statement.
✓
Personally Known OR Produced Identification
Personally Known " OR Produced Identificat10A%0A%
Type of Identification
Type of IdentificationProduced Produced(Signature
of Notary Public- to of Florida)
(Signature of Notary Public- S toGof FloridaCommission
No.
Commission No. & Z6 (�6Z (Seal)
c ry Pudic State of FbriEe
Kristi L Huffman
'14ej
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REVIEWS
SOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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