HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . _7"y Permit Number:
03
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applica ion MAP 12 2020
Permitting Department
St. Lucie County, FL
Commercial _ Resl -nttat --- -
PERMITTYPE:
PROPOSED IMPROVEMVENT LOCATION
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Aaaress: LyorCST LorY.tr aF �Y%ctr,o I Col• s
Property Tax ID #: q - I Li 4 - D OOo - 000 - 0 Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION`S '
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
X Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 4_2520 Sq. Ft. of First Floor:
Cost of Construction: $ 6 gl 000 Utilities: _ Sewer _ Septic
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE
CONTRACTOR: J
._.,...
Name 2„r1r;o �e �a �, �. ;cc
—
Name: ' SAKT- % ��Nnr-,OOy
Address: V; a l4P,.,4S
Company: W I L_Sar\LS
City:ye_ro Rena State: FL
Address: 203 5&4Tj) SJ'V3
Zip Code: 32-9 (0 3 Fax:
City: FD(z7- P State: FG�
Phone No.
Zip Code:. `f Faxw- '_
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail fn ®-' lti/I /_<Q��7_P4Y a 19k�
from the Owner listed above)
State or County License C). c /0s- Wlyl
IT Value OT construction is 4zbuu 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: r-,cl� _ ,—�c�<•,oc�
Name:
Address:��,.1�,',��; �,,,�
Address:
Cittate: --kX
City: State:
Zip: --I �OACfl-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 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 LENDER OR AN ATTORNEY BEFORE RECORDING R NOTICE OF COMMENCEMENT."
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Signature of wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License o er
STATE OF FLORIDA ,
COUNTY OF
STATE OF FLORIA
COUNTY OF 5
The for oing instr ment wa acknowledged before me
this day Qf 9CM 20�by
The forgoing instrument wa acknowledged before me
this day of 20 by
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40
Name of person making statement. _° 4
Name of person making statement.
Personally Known OR Produced Ide ifi2tY,�n `
Personally Known OR Produced Identificati n
Type of Identification 0o 71;
Type of Identification y
Produce 3 �
Produced
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g Not blic- State of Florida) ,I" _ G) m =
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(Signature of Notary Public- State of Florida )
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Commission No. (Sea -0. $ T (n
Commission No� Q✓ (Seal)
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DATE
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COMPLETED
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