HomeMy WebLinkAbout Building Permit Application it
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (�00 ay��
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RECEIVED
Building Permit Application JUL. 2'9.2020
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercia I Residential Lucte County
2300 Virginia Avenue,Fort Pierce FL 34982
one: (772)462-1553 Fax: (772)462-1578
PiERMIT APPLICATION FOR':
PROPOSED IMPROVEMET LOCATION
Address: .FYI 7 A T-el` . 1711 PieJ0L M, 3'60-
Pr I perty Tax ID#: 1Q2-,M--M/1 ~O00^SL- Lot No.
Site Plan Name: Block No.
Pro ject Name: O r� nnP,l.l
DETAILED�DESCRIPTION:OF,.WORK HV
'TA f J P(d>ckVXQ: y SNA•2SS &Ncs �On �610.,� 7-
proock,_c
—mac \►I`ec��e�c;.s"�-S' o n l���e�`�/�
New Electrical Meter Second Electrical Meter
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CO`NSTRU,CTI ON<I N'FORMATION
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank C Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Ti tal Sq. Ft of Construction: /()o Sq. Ft. of First Floor: IS
Cost of Construction:$ /of 0-OD Utilities: —Sewer _Septic \Building Height:
;OWN-ER/LESSEE y CONTRACTOR s Fr t
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�IName �BMc�Si �i�Dc A+n 0`fU4Ae11 Name: W o. Q�i nA
Address: —Rz, ,( 'e,^ Company: Ow,,)
Ci ?rel`Cl. State: Address:_.SI 1-4- l5W SO er-U
Zip Code: 3t{Or 1 - Fax: City: ont* Sc;c,Z-v 2-U e,x le_ State: FL-
Phone No. Zip Code: 34%� Fax: 7Wa-3n 07�'s
E-Mail: 4-L3 eJ0AA-C11 (@"i-A)C • Phone No 772--D4 = a->9y
Fill in fee simple Title Holder on next page(if different E-Mail COM
from the Owner listed above) State or County License C°_(�LIIen�S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,�a RECORDED Notice of Commencement is required.
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SUP'PLEMENTAL> CONSTRUCTION LIEN 11A INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
C1fty• City:
Z�p: 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 I�Ionsideration 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
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Signature of Owner/Le ontractor as Agent for Owner Signature of Con ctor/License Holder
STATE OF FLORIDA STATE OF FLO A
COUNTY( .d COUNTY OF
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Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization ysical Pre nce or Online Notarization
#hi day o 2020 by thii7R day of 2020 by
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'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
P oduced Produced
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(Signature of Notary P ic-State of Flori ( atu a of Notary Public-Ake of Florida)
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j Commission No. Commission No. (Seal)
s�a�apuN allgad�Ue1oN N4.1 PaPUo9 ;ao�i iO�1e_
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0909LZ 09#NOISSIWI"400 Ul - ' =
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REVIEWS FR NTIMWH il41lVWH PLANS V Na: 3�IQaTI# �f ANGROVE
CO IEW REVIEW g (y01SS1 LNC1 ;2 REVIEW
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TE PNIlNHt�° ••x;;d". ,
CEIVED
DATE
COMPLETED
ev. 5/6/20
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