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HomeMy WebLinkAboutnaugle permit0001All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater I oZ-Qc7-© Permit Number:
8 Building Permit Application
lomw ... __ .
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
4fi2-1.578 Commercial Residential
_ ---X.--
Phone: (772) 462 2553 Fax: (772)
PERMIT TYPE: pm
PROPOSED IMPROVEMENT LOCATION:
I
_
Address:
Property Tax ID ##: 1 " Lot No.nun
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
i
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply:
Gas Tank _ Gas Piping _ Shutters Windows/Doors
_Mechanical _
Pitch
Electric _ Plumbing _ Sprinklers _ Generator Roof
Ft. of First Floor.
S 1
Ft Construction: rl-
Total Sq. of
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 1
Name:
Address: �.`
Company:
'P
City: State:.. •
Address:�
City: Stater
Zip Code: �j� i _ Fax:
Phone No. 1114 . (n o l - al o 1 �
Zip Code: , �. Fax: i
i
`
E-Mail: 1. �
Phone No
Fill in fee ' ple Title Holder on next Plate ( if different
E-Mail
&n
from the Owner Iisted above)
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.
I SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State -
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:, �nr
City: State:
Zip: 552,14(, Phone:i t '
BONDING COMPANY:
Name:_
Address:
City:^
Zip:
Phone:
Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indirated.
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 s:.=ch
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 N"CE OF COMMENCEMENT -
Signature,~6f Owner/ Lessee/Conti ctor as Agent for Owner
STAOF FLORIDA
COUNTY OF
The for 'ng rostrum n ac no ,ledge efore me
this day of ZC)by
F"
-C I rnn � Ir,
Na e of person making ateme t
Personally Known OR Produced Identification
Type of Identification
Produced
Signature
STATE OF FLORIDA
COUNTY OF
The 'Fay'ME
g owI dg efore me
this by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
(Sigriat S3f N19 a[3it- h S to Egrida ) KATHERINE HAVENS Stgna
?' D,tY COMMISSIOi'4 066165030
Commission No. _ E ,, � (Sea#IRES: DEC 04, 2021 Commission NO.
Bonded through 1st State insurance g
ZONING
PLANS
REVIEWS I FRONT COUNTER I REVIEW SUPERVISOR REVIEW REVi W VEGETATION
DATE
RECEIVED
"' KATHERINE HAVENS
MY COMMISSION #GG165030
(SW'}RES: DEC 04, 2021
Bonded through 1st State insurance
SEATURTLE I MANGROVE
REVIEW REVIEW