HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
COMPitirCD FOR APPLICATION TO BE ACCEPTED o
Date: �/, Permit Numbe
F R E C E I
WE,
'`': MAY 1
Building Permit Applic tion 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Luc'e ct
2300 Virginia Avenue, Fort Pierce FL 34982 011nYr F
Phone: (772) 462-1553 Fax: (772) 462-1578 , Commercial Residential
PERMIT TYPE: �3 2+0 rV e C44-10� pe'l ,, C,0Y
JPds-0a,@,S-,1§PJ1'M',PRONEMENT LOCATION �'
Address: �qq® Gter ggA P _. 0.
Property Tax ID #: 2 - 5 005— 0 boD Lot No.
Site Plan Name: _qi We _
Q-r_ S c Cc,L4 0- Block No.
Project Name: !E i yvl e-5
ll�
Additional work to be performed under this permit -check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters �WiQdows/Doors
i�Electric �umbing �3pr' _Generator _Roof Pitch
Total Sq. Ft of Construction: �'-T -76 � '63 q. Ft. of First Floor:
Cost of Construction: $ q�Tr} Utilities: Sewer _ Septic Building Height:
Name CT -14a !.12 fvdl�
Address: I (y S Cyl Q kl( o
r sue;
City: State: (—
Zip Code: Fax
Phone, No. 6y "
E-Mail: 4 `ins .. C/�. C",eI/1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: / f 3J %f�' 51 L (4 C!e 5 (� j
City: P J -7- Lu.!_],p Stater'
Zip Code: g1F2— Fax:
Phone No ?Z2 37O -- O7
zl—
E-Mail
State or County License CrL4bZ(�
IT value of construction is 5Z500 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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DESIGNER/ENGINEER: Not A plicable
Name: �� D It �� �fi�l��gsTr,�f
Address:O
City: 07 ,-e-e_ State:"wF
Zip: J0 Phone* 77Z 3,Z1. tf 3011
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City: _
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:.
Not Applicable
State:
BONDING COMPANY: Not Applicable
NarrI
Address:
City:_
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
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STATE OF FLORIDA -
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The fo oing instrum nt was acknowledged before me
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
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(Signature of,Notary Public- tate of Florida )
Commission No. ;.Y"�''; LASHAHNAINGIHMING
"(Signature of Notary Public-S to of Florida)
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Commission No. NMI
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DATE
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58
DATE
COMPLETED