HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO M'UUS,T/ BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�
Date: [ ' 7 9 Permit'Number f� v
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Building Permit Application JUL 26 2019
Planning and Development Services P�rl1"I I�t�rl
Building and Code Regulation Division g DepartMeir
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lu County FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resl en '
PERMIT TYPE: ----De+- CzGh e k AA f0,Pp -
Address: 1 g .r I'
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
(ice- 1Dc*yh cm-nn
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _ Gas Piping _ Shutters
✓Electric JP//lumbing _ Sprinklers _ Generator
Total Sq. Ft'of Construction: ` g-00
Cost of Construction: $ 6, 0) COO
Sq. Ft. of First Floor:
indows/Doors
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
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Address: C)j,
Company:
City:_
•Code:
Phone No.
A••
Fax:
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simpleFill in fee • • on •.
from the Owner listed above)
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.
I
MORTGAGE COMPANY: Not Applicable
Name:
ENGINEER: Not Applicable
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Address:
City: O•r� .. 5F r
Zip: -?yy y6 Phone S'—d/' %
State:
�s� -�6�
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 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 YOUR L EI2-OR A ATTORNEY FORE -RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of
er/ Lessee/Contra or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
�'
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrvrnWt
was acknowledge,d�pefore me
The forgoing instrument was acknowledged before me
this `L' ay of
20_ by
this day of 20_ by
Fra
-
Name of person making statement.
Name of person making statement.
/
Personally Known
OR Produced Identification
Personally Known OR Produced Identification
Type of Id ti ti n n,
Type of Identification
Produced
Produced
(Signature of N
ry P ic- State of Florida
(Signature of Notary Public- State of Florida )
Commission No.
AUDR Y B. UMPHREY
Commission No. (Seal)
`O1�,pY
V; MY COMMISSION # GG 300817
REVIEWS
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EXPIRES:
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW,
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. L/ // 1y