HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1-9N.2C20 Permit Number: aoaf-03a3
• JAN 21 2020
-- --_ Building Permit Applic, We County, Permitting
Planning and Development Services g
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential`
PERMITTYPE: �d1
Address: 3-3 -5- t1 - /LVL
Property Tax ID#: Syd— U0-�
Site Plan Name:
.Project Name:
8C)01C
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2 91P
Q . — .
_ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
GONTRA @R:
Name:ScN�
Name
Address: 33'�) 5E7 -l1-cy---A
Company: \)y `v^e �h C_
City: DS L State: _
Zip Code: vb� Fax:-n a - 232o • Lo9z
Phone No. 3c>5-Sc)N -�-AN 'I
Address: --Sss 5�-- fi(L C-V' r! —�-\ \y
City: -P SL State-T--4-
Zip Code: `3L-kci (N'�> Fax:
Phone No 17F -9 1 q ni lo2CO
E-Mail: Gri c-kc- 38 200 �a "-CLA))
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
1
E-Mail cr v �-� `^� �� �" •Cc w�
State or County License C C- Y-t5�2 \Z
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.
UPPLEME- TAL CONSTRU
ION LI N
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01
10
MORTGAGE COMPANY: _ Not Applicable
Name:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 tobuild 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."
S re of Owner/ Less ' ractor Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk. t-% ci
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thisday of 20 as by
this _ day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced rC� Q�-
Produced '
(Signature of Notary PuMic-S ate
NpMAR1E,r 1���
DEMNhM
0*4 ture of Notary Public -State of Florida )
Commission No. 00
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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