HomeMy WebLinkAboutBuilding permit application 05/15/2020 14:36 7723403050 THE UPS STORL PAGE 01
All APPLICABLE INFO MUST BE COMPLETED FOR APPLI:ATION TO BE ACCEPTED
Date: �"� Permit Number: Q
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Agriculi ure Exempt Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 84982
Phone:(772)462-1553' Fax: (772)462-1578 Cc mmercial Resident-al
PERMITTYPE: Loca)1r'a
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Property Tax ID {'� ` O� jt�o • _ Lot No,
Project Name:
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Name ECi'LRe 0 0''\ _ Name:
Address: L''�4Co QU rP'f _ Company; _
City: Pay - 95_� -
%A_ Stater -- Address:
y
Zip Code, Fax: City: State
Phone No. 3 _ Zip Code: F ax:
E-Mail: 11` 4 0� I a Cary _ Phone No
Fill In fee simple Title Bolder on next page(if differ-int E-Mail
from the owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Not Ice of Commencement Is required.
AC-5_5 �� ,mss
05/15/2020 14:36 7723403050 I THE UPS STORE PAGE 02
u o 00 or more; RECORDED Notice of 0 immencement Ii required.
If value f HVAC is 7 5 q
M
DESIGNCR/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: _ Name•- -
Address: Address:
City: __- State: City: -State.,
Zip: Phdrie _ 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 here)ly made to obtain a permit to do the work;Ind installation as indii ted.
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 p irmit will authorize theermit holder to bL lid the subject structure
which is in conflict with any applicable Home Owners Associa:Ion rules,bylaws or anfcovenants that m.y restrict or prohibit such
structure.Please consult with your Home owners Assoclatior and review your deed or any restrictions•vhich may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,pet Form the work
In accordance with the approved plans,the Florida Building C ides and St.Lucie County Amendments_.
The following building permit applications are exempt from t,ndergoing a full concurrency review:room additions,,
accessory structures,swimming pools,fences,walls,signs,sc,een rooms and accessory uses to another Ion-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD ,1 NOTICE OF COMMENCEMENT MAY li IESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERI Y. A NOTICE OF COMMENCIEMENT Al UST BE RECORDED! AND
11-051ED N THE J06 SITE BEFORE THE FIRST II ISPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT
"ITH YAVR LCNDER OR AN ATTORNEY BEFORE R ECOR13ING YOUR NOTICE OF COMMEIII:EMEATI'."
Sig a Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Hot(er
STATE OF FLORIDA- — STATE OF FLORIDA
COUNTY OF Irrje COUNTY OF
The forgoing Instrument was acknowledged before me The forgoing instrument was acknov•ledged before me
this Z5— day a 2PO' by this day-of ,20_ by
Name of person making statenw. Name of person making statement.
Personally Known oR Produced Identification _ Personally Known OR Prodi Iced Identification
Type of Identification Type of Identification
Produced Produced
41griaiure of Notary Publi . o rl a (Signature of Notary Public-State a• Florida)
otary ublio State of Flor da I
Ann M Giasi
Commission No My r9aianGG=3•9 Commission No.
�) (Seal)
L; sSo��i�2or3
REVIEWS FRONT I ZONING SUPERVIS 311 PLANS VEGETATION SEA'•URTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW RE'fIEW REVIEW' .
DATE
RECEIVED
DATE
COMPLETED
ev.
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