HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t n
Date: Permit Number: �y1 L� o lk
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Building Permit APPt io
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Planning and Development Services 10,°°?
Building and Code Regulation Division Commercial xx 'L�Resiclential
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
� r®gs3; , Rouln�luT.l*oc o _ y �
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Address: 3406 DALE PL, UNINCORPORATED S/AINT/L�U/C�IE COUNTY
12
Property Tax ID#: 10 l-! — yV 13 CCO - Lot No.
Site Plan Name: 3r��r Z>44� R l' Block No.
Project Name:
A)l.E� lSCRIPTIC�IEF wo ' ' _ 6 .
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New Electrical Meter Second Electrical Meter
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,Sk�'w 'a ._��� 'a.. . '�$saY,}ar a , - -�
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Pond
Electric _Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: f d Sq. Ft. of First Floor: r�S&6
Cost of Construction: Utilities: —Sewer —Septic Building Height:
44
Name Name:!Lt-i+-
Address: Jq-K1 cc y'c --hip�-O Company: 'n���( 9�--
City: L,�) )G l� State:-T7- Address: / 114 5 '"7�
Zip Code: 7C3'�;/,6 L Fax: City:Prang dA J Stater
Phone No. 9!Se/- Zip Code:3?066 r Fax:
E-Mail: Phone No q�' ?6- 2-
Fill in fee simple Title Holder on next page(if di erant E-Mail Cjc ��- AC
from the Owner listed above) CCU Ca,S-�- tate or County License 62 OV6 Qel
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
If value of HAVC is$7,500 or more,a RECORDED Notice of Commencement is required.
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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 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County a p on the jo site before the first inspe ton. If you intend to obtain financing, consult
with lender a befor commencingwork or rec r our Notice of Commencement.
Signature o O ner/Less C ra r as Agent for Owner Sir�lRn—tracfor/License Holder
STATE FLOR ST TE O FLORIDA
TY OF BROWARD CO Ni OF BROWARD
Swor o(or affirmed)and subscribed before me of Swor�to(or affirmed)and subscribed before me of
Physical Presence or Online Notarization _✓P,lhysical Presence or Online Notarization
this--'`day of 7P -p t\n,1wt✓,2020 by this�day of M C Pi PSI!2020 by
JAYSON ONESCHUK JOHN SETTON
Name of person making
gsstatement. Name of person making statement.
'
Personally Known `_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Idenjtification
ed Pro 4_10,;� Ac. �� rS L
(Si nature of Notary Pub "Pb'
I YP�' RICIA ANNCHACON ( gnature of Nota W, ate I
�o. �:. *: *. MY CO ON£�GG 361474
Commission No. *; ;*; M�P��QMISSION ff GG 36147 :��. ,oa EXPIRE 1,2023
oQ: 3CPt12ES August1,2023 C mission No. =,9,•.. .•P,= 57
ded ThN NdfaryPiblic Underxriters
9repF �` Bonded Thru Notary Public Undenari s
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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