HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^Q
Date: Permit Number •C) 750
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Building Permit Applicatio '
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT TYPE:
NIN
Address: �� �o 'T ��' cS%
Property Tax ID#: 141,90 • 70d�Dot Zl' 000 q Lot No. 0Z-3
Site Plan Name: Block No.
Project Name:
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Additional work to be performed underthis permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping —Shutters =Windows/Doors
_Electric _Plumbing —Sprinklers —Generator „ Roof - Pitch
Total Sq. Ft of Construction: 70 Sq. Ft. of First Floor:
Cost of Construction: $ /; 0-0-0 Utilities: Sewer Septic Building Height:
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Name .J � 01�u z Name: e
Address: 0' 4z Zs' )91 ST Company:
City: cr `e,-e¢. Stater Address:
Zip Code: Fax: City: State:
Phone No. %VZ & V3 Zip Coder Fax:
E-Mail:&cz,� ,tic 33 0 L.fy... Phone No _
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,560 or more,a RECORDED Notice of Commencement is required.
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,,perfdrm 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: FOUR 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 Signature of Contractor/License Holder
'STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a-, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �� day of_ 20� by this day of 20_ by
1M �►�S`c�nod�c,
Name of pe on making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
gn ture of Notary Pub ,State of Florida (Signature of Notary Public-State of Florida )
RAHM ING
Commission No. ,tip e;4 -, IAiHAtti�NINZ (Seal)
my-COMMIS R IG275060 Commission No.
EXPIRES:December 20,2022
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JCOF f-� k3oT dedT (V 0
REVIEWS ; KING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW - REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 217119