HomeMy WebLinkAboutBuilding Permit Application°h
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All APPLICABLE INFO' MUST BE COMPLETED FOR -APPLICATION TO BE ACCEPTED
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Permit Number: �0 _
Date:
Building.Permit Application
Planning ond'DevelopmentServices /
Building and Code Regulation Division Commercial Residential V
2300 ifirglnio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 9 +-'9 c---/-`5 —/ /J\J 00
�
PROPOSED. IMPROVEMENT LOCATION: '
Address: LID �- W I LLO 6yc-:--
Property Tax lD'#: _ -3c/1 l - 5 U O I- 0o()' () Lot No. ! a -
Site Plan -Name: t: L�12 /. �/�f Block No.
Project Name: / LC-C-37i�_ L� / 1� r-G(—
I. DETAILED..DESCRIPTION,OF WORK:
0!/2` It-
A104-4- /fir~ 0 7,�5. 0
15TiNG /( x
II New Electrical Meter E _Second Electrical Meter tf
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CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply: 9;"4 GA-RA-6c-D00(?-
>&gchanical J> � as Tank '�, 6as Piping ��Shutters I1 s/.Doors �/ and
Electric i�L Plumbing '� Sprinklers r. Generator /L Roof - Pitch.
Total-Sq. R of Construction: Sq. R. of First•Floor:
Cost of Construction: $� Utilities: _Sewer `Septic Building Height:
OWNER%LESS-EE:
CONTRACTOR:
Name LG-�
Name: LG/6-D 0 es�-�
Addrem: Ave- ,
.Company:
City: r' :57 4-Ur_i -State: .
Address, /�� c IIJ v6'�1
Zip Code, s� Fax* �/�-
City: D®`2 ,4A1 v t3c# -�—
Phone No. l �`" o� �(� - c� j a- i
,-State:
Zip Code: 3�- Fax: i�-
E-Mail: //-
D
Phone No Vc-)L— &z6_!5_6
Fill in fee simple Title Holder on next page ( if different
E-Mail (PQ IM - dw r Cp
from the Owner listed above)
State or County Licens4 C8 C 0 � 3 ! 3 -z
it value or -construction is 2500 or more, a -RECORDED Notice of Commencemdnt is required.
If value of HAVC Is $7,500 or more, a RECORDED Notice of Commencement Is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable 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 con'ilict 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, wails, 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 lander nr an attornev hefore comMencine work or recordine vour Notice of Commencement.
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nature of Owner/ Lessee/Contractor as -Agent for Owner
ignature of Contractor/license Holder
STATE OF FLORIqA
STATE OF FLORID
COUNTY OF D904'�A-e't
COUNTY OF
Sworn to (or affirmed) and subscribed before me of
Sworn to (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Ch Physical Presence_or Online Notarization
this Z--day of . 20'1a by
this day of _ Qk- 20 Z by
t)1,—W 14 �o MA-,&J (� c./
��N �J �S V� 6 �-t � L� c,
Name of person making statement.
Name of person making statement.
Personally Known OR Prod tification
Persona ow�i n _�_ OR Produce fication
Type of Id tion
T of identification
Pr d
roduced
( re of Not P5
ture of Not Pu
HE �Z
RAMIREZ
=O"Puri
ommission N 193990
l6, 2022
MY COM # GG193970
Commission EXc az 16,2022
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o10 EXPIRES: Marc
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FRONT
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SUPERVISOR
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Kev. S/uf zu