HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP'__:3D FOR APPLICATION TO BE ACCEPTED
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Date: �� Ll • ) Permit Number: 7 �d�' 15-sm Fg-- - :F d- F I.'%# E D
Building Permit Applidation DEC -9 2019
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
PERMITTYPE: Xv f ar-
PROPOSED IMPROVEMENT'LOCATION:
Address:
Property Tax ID #:
Site Plan Name:
Project Name: _
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters
/
_ Electric ✓ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
1 I C7q 7�
Cost of Construction: $ V
Sq. Ft. of First Floor:
Permitting Department
St. Lucie Co�ntyl FL
Lot No. 1
Block No. 6-
Windows/Doors
Roof Pitch
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE;
CONTRACTOR:
Name 1
Name:
Address: I(-
Company:
m n
City. Stat—ly V
Zip Code: 3� F z.
Phone No. U 70
Address:
City: State
Zip Cod �J 1�1 Fax:
Phone No �'a. 02�7 e)'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail.
State or County License �D
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.
SUPPLEMENTAL CONSTRUCT" I LIEN LAW INFORMATION:
MORTGAGE
Not Applicable
Name
Addre
Zip: cj1 4l4 Phorie(YQNt 1 j Q`
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
ress:
State:
Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
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 YOU NDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO CEMENT."
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Signature of Owner/ Lessee/Contractor as 9 t for Owner
Signature of Contractor/License Holder
STATE OF FLORI�A/
STATE OF FLORIDA
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COUNTY OF v�
COUNTY OF
The orgoing instr pt yva cknowled efore me
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The rgoing instr n w
this day
acknowled before me
20 b
this dayof
of
Name of person making tatement.
Name of person making statement.
,y
Known Personally OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Knn� 1/(rnQv�,
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Signature
(Sig (Sig
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""""•••.,•. KARLEYMARIE GIESY VARt ��
Commissi 14�VY
�P` State of FIcA*al
KARLEYM GIESY-VARNEY
`O`er,""I -
Notary Public State of Florida
Com 4s0 ,� 801
(Seal)
CommissionMGG 099801
MYCOMM Expires May 1, 2021
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REVIEW REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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