HomeMy WebLinkAboutBuilding Permit Application{
.All APPLICABLE. INFO'MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
Date: Permit`Number:' 020 �' da 4-6
Building-,Permit.Application
' Planning, and. Develo pmen't-Services
Building. and Code Regulation Division
2300 Virginia. Avenue;.Fort Pierce FL 34982.
.0h6ne:,.(772)462'1553_ Faz:.('772)462-1578-' „ .co11' menial Resid@Iltial_
PERMIT TYPE:: . .
PROPOSED'LMPROVEMENT'LOCATION.
ail
AUOre55:. _ 4 46-? IQ 4y f/ _Zm_ I ir.cJ
Property Tax ID. #: /3 l .3. - 22 'Lot No:
'Site Plan Name:. 'Block NO. .
!.ProjectName:...��T,?D
DETAILED'DESCRIPTION' OFVbRK: ✓`
�.
, -.. 11 ISM2 Am
CONSTRUCTION"INFORMATION.
Additional work to"be performed. -under this.permit:— checkall that apply....
_Mechanical: - Gas.Tank . .: Gas Piping' 'Shutters .. Windows/Doors. .
:Electric`. _Plumbing. ". Sprinklers __Generator _ Roof Pitch ,
Total S.q: Ft of Construction:, . Sq.-Ft; of First -Floor::'
Cost of Construction: $: . Utilities:. _ Sewer _.Septic. . Building Height: .
OWNERAESSEE: .'.CONTRACTOR:-'..
Name:��R>/1!
`Address:- C/ N iYti.a..., R&4nh E'jVo
Company:
City: Al .1Wv A4,1 O—A,4G12 ' :States /
Zip .Code: Fax:'
Address:
-City:, LU� Stater
-Phone. No,
`Zip Code: L�d7 Fax:
E=Mail:: ..
Phone No ' 1.2 q2'
Fill in.fee.simple-Title. Holder on next page.(.ifdifferent ..-E-Mail
Din.4' a' /�c°�21h� X Sdy; •GO�j .
frOn1•the Owner listed above) , '
State or•County.License
Ifvalueof•constructionis' 2500or•more,:a:REC.ORDEDNotice'of•Com:mencem.entis`required.:
If value of HVAC.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: Stater .
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/ CONTRA•CTOR.AFFIDVIT: Application, is, hereby made to obtain a permit to do the work and installation as indicated.
I certify,that no work or installatiomhas commenced prior to thelssuance 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 Horne'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 l'will, in all respects, perform the work
in accordance with:th e.a p proved plans;.the Florida Building Codes',and.St. Lucie County Amendments.
The followingbuilding permit applications are exempt,from undergoing a full concurrency review: room additions,
accessorystructures, 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 LENDER OR AN ATTORNEY BEFORE RECORDING YOUR_ NOTICE OF COMMENCEMENT;."'
Signature of Owner/ Lessee/Contractor. as Agent for -Owner
i9Kature of Contra cttor/Licerise Holder
STATE OF FLORIDA
STATE.OF:.FLORIDA ,.
COUNTY•.OF P,ci .T ... :a t
COUNTYOF4alj�&ca 4
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
this .ZJday of .1. L 4 : 20Z0 :6y
this P4 day of L 20 by
Name of person making statement.
'Name of person' making statement. '
Personally Known Sc�n OR Produced- Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
My COMMISSION # G
(Signature -NotaIm'ThruN
( g ry-Ma3
Si nature of ota Public- State nded Thru.Notary Public
OMMISSI N # GG 950453
No.
XPIRF 23 2024Commission
)'
Public Undeiwrlters
Commission No.C49T0�� (Seal)•
GGlSbgS 3
tary
REVIEWS
FRONT
ZONING
SUPERVISOR,
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER.
REVIEW
'REVIEW
REVIEW
REVIEW
-REVIEW
REVIEW
DATE.
'RECEIVED
DATE
COMPLETED
rcev. / xv
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