HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: % 9 • �?JZ Permit Number:,
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
3- O-4ZV
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MAR 18 2020
Permitting Departmer
St. Lucie County, FL
PERMITTYPE: kJeo-j r7)A7h'v —
PROPOSED IMPROVEMENT LOCATION:
Address: L 610 1 (320 q'ie s Rn KI'n 'C-C)ILT p AP9 F�
Property Tax ID f1: (3l3 ' 13a -0003 - CC) 0 1 I Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _ Gas Piping _ Shutters
Electric ✓ Plumbing _ Sprinklers _ Generator
V Windows/Doors
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor• (Intl
p_n r
Cost of Construction: $ �14. CS .00 Utilities: —Sewer _ Septic Building Height:
OWNERAESSEEa
CONTRACTOR:
Name ' iiA
.pry
Name:
Address: 4ei 1 GsouuS PA
Company:
City: t-o!N A:rWLQ_ State:'PL-
Zip Code: S4OW 1 Fax:
Phone No.
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 2Put2�4si��e! u�� rm cr,w� _
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
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. ^ 3A
\- -
DESIGNJR/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: R8tA
_
_
Name:
Addr ss. a
Address:
City ork5m`n, L.c«ie.
StatesiFL
City: State:
Zip: O Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City: -
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIUVI I: Application is hereby made to obtain a permit to do the work and mswuaudn
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
w"H YOUR LENDER OR AN ATTn0111FV RFFnRF RFCOR1171ING YOUR NOTICE OF COMMENCEMENT."
Signature of ner/ Lessee/C ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
.
COUNTY OF LJ�
COUNTY OF
The fogging instrument was acknowledged before me
% O ii—
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of p , 21�,"by
_
Name of perso making s atement.
Name of person making statement.
Personally K own OR Produced Identification
Personally Known OR Produced Identification.
Type of (dent fi Ion
Type of Identification
Produced
Produced '
�( f�J16 rr
(Signature of tary Public -State of Flo Ida)
(Signature of Notary Public -State of Florida )
Commission No. 31 AUD NUMPHREY
Commission No. (Seal)
MYCOMMIISSSIION#003M17
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PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ // 13