HomeMy WebLinkAboutBuilding Permit ApplicationAI PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I ' , n' Permit Number: I
G
RECEIVED
Building Permit Applicati n JAN 10 2019
Planning and Development Services
Building and Code Regulation Division ST. Lude County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
Address IDS MYY 1(y1 n CLCA P+ 'St. • Ll iU� � 3LG191
Property Tax ID.#: ),0C 7l�—DOQ1-000 b Lot No.
Site Plan Name: Block No.
Project Name:
hStUA100b an Q fnt, ► l �n
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Additioogalwork tobeperformed under this permit —check all that ly: �S Lq l v
i�echanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
VJM
VElectric ✓Plumbing�J _Sprinklers _Generator Roof Pitch
j
1 I Zq
Total Sq. Ft of Construction: 1 Sq. Ft. of First Floor:
e
Cost of Construction: $� Utilities: —Sewer V Septic Building Height:
Name f1� l its Name: L• Jr-
p�
AddresjIOS lklY �1f/Yt ( Com pa ny: 4(� 1T. jin Will v? `nM i
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City: I T • 7f • W CAPe State: _ Addressss.1aus
Zip Code: s 1 Fax: City: State:_
Phone No. 'I `1a. -J�$D—�3�� Zip Code: Cj 1 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on n4A page (if different EMa' it _�N1(Yltlpi �' �t iY�S��TY1�1)(_(OL
from the Owner listed above) State or County License--H--1� 37
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.
_ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name: 5KU I Inc, Name:_
Address: Address:
City: State: City: _
Zip: Phone Zip:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I 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 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 COMMENCEMENT."
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDg4
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WCA y�
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COUNTYOF �•t_•�
COUNTY OF
The forgoing instrument was acknowledged before me
The fpLgQing instru ent was acknowledged before me
this � Nay of C b*c, iX'..r
, 20 1�9 by
this _ day of c Ck k'-1 20 2-bby
Name of person making statement.
Name of person making st ement.
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Type of Identification
F LOL-0-�l�jr2163)L,�LiJG
.2 .� :.
Type of Identification
Produced
Produced
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(Si ature of Notary Public-
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Commission No. Ly D
Nota Public State of Florida
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natu e o Notary Public- St
K.� Notary Public E28i
I „( _�1C1 uli Baird
C mission No. l�`!�o( 6 i� mmissio+�
S� My Commission GG 281841
Expires 12/05/2022
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@a t<T Expires 12f052022
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