HomeMy WebLinkAboutBuilding Permit Application FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number: V�v
RecErVEL)
Building Permit Application
M, DEC 0"9 2020
Planning and Development Services
P@FfflftVr19 Department
Building andlCode Regulation Division ude County
2300 Virginia Avenue,Fort Pierce FL 34982 �7
Phone: (77i)462-1553 Fax: (772)462-1578 Commercial Residentiaf
PERMIT TYPE:
L4
Address: 6...10 k] 1eice, FU z1*41
Property Tax`11)#: qo(y 508 08q0 o0p Lot No.
Site Plan Name: I Block No.
Project Name:
DIDESGRIPTION R
F6b- 10204 - SUPCX; r6he-dS
Additional work to be performed under this permit—check all that apply:
MechahicaI _Gas Tank Gas Piping i
Shutters Windows/Doors
Electric I Plumbing Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. ofiFirst Floor:
Cost of Co nstructio n:$ DO Utilities: —Sewer Septic Building Height:
N '-
ame , I)h Y1 la r�nn L Name:
Address7
- 6+' Company:
City: State:_E L Addressi
Zip Code: A(494r) Fax: City: State:
Phone No. I q6_,5 0
Zip Code: Fax:
E-Mail- ;"(Pue_An 0.14�+,ro6i, Phone No
I I —
Fill in fee sl ple Title Holder an next page(if different E-Mail 1
from the Owner listed above) State or,County License
If value of construction is$200 or more,a RECORDED Notice of Commencement is required.
If value of HVAi is$7500 or more,a RECORDED Notice of Commencement is required.
I
S' PLEMENTAL CONSTRUCTION LLEN LAW INFORMATTIION:
DESIGNER/ENGIN_ER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: gel (.l',1dQ1 n Name:
Address: I Address:
City: I. State: City: State:
Zip: Phone Zip: I Phone:
I I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: 1
Address: Address'
City: I City:
Zip: I Phone: Zip: ' Phone:
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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 nop-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RE!'aULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE;OF COMMENCEMENT MU'iT 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 WOW Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder'
i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ' COUNTY OF
The f oing linstru ent was acknowledged before me The forgoing instrument was acknowledged before me
thismda Of 20_Qoby this I day of 20_ by
i
Name of person making s atement. Name of person making statement.
Personally Kno OR Produced Identification / Personally Known OR Produced Identification
Type of Identificat! Type of Identification
Produced I 1 C►• Produced
I '
l ,
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. AUqgg6q HU?dPHREY
MY COMMISSIONGG300877 i Commission No. (Seal)
EXPIRES:March 6,2023 F.
Bonded Thru Notar i Public Underwriters !;
REVIEWS I FR ON T 7 W R d 1WffRWfdO s PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ' REVIEW REVIEW REVIEW
DATE I
RECEIVED
DATE �
COMPLETED
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