HomeMy WebLinkAboutBuilding Permit Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�l
Date:>� • �` �\ Permit Number: !�'
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Planning and Development Services APR 12 1021
Building and Code Regulation Division Pwrrlitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 ResidentialSt. Lucie County
Phone:(772)462-1553 Fax: (772)462-1578 Commercial
PERMIT TYPE:
Address: � (� 7, +/E'J D. ,vt toy to
Lot No.
Property Tax ID #:
Block No.
Site Plan Name: AW Sl-(i
Project Name: /?eOEM gip.-
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Additional work ta,be performed under this permit-check all that apply:
_Mechanical Gas Tank _Gas Piping —Shutters
W in,dows/Doo.rs.
Electric —Plumbing _Sprinklers _Generator —Roof
- ' Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ /�� CJ Utilities: _Sewer _Septic Building Height:
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Name
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Name�; t - - C
r Company rC:;.Ct��::C f-a� �U'S
Address:,.�Sl Io l,'���oco _
City: state:�L Address.
I City &�Oe°� S t? �Lc::c� a Stater
Zip Code: 3' `� 5 Fax
PhoneNo. .. Zip Code: Fax:
Phone
: Phone No 772, 216- 3 ��
-�. �b j •Ca�'-�
Fill in fee simple Title Holder on next page( if different E-MailT( r
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$7,500 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, 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,
screen rooms and accessory uses to another non-residential use
accessory structures,swimming pools,fences,walls signs,gns,
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT.IN YOUR PAYING
TWICE FOR IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTE® PINI T JOB SITE BEFORE THE FIRST INSPECTION. IF YO_ INT TO OBTAIN FINANCING, CONSULT
WITH Y R I DER OR AN ATTORNEY BEFORE RECORDING YOU 0 E COMMENCEMENT."
Sign ure of Owner/Lessee/Contractor as Agent for Owner Sign re of Contractor/License Holder
S ATE OF FLORID ATE OF FLORIDA
COUNTY OF COUNTY OF
��CI�
The, doing inst e t wa acknowledged before me The forgoing instru e wa acknowledged before me
this day of 2 ,by this of 20CA\by
K �rdCC ►,,
Name of person making statement. Name of person making statement.
/ Personally Known OR Produced Identification
Personally Known OR Produced Identification Y
Type of Identif' iQn Type of Identifica , `h
P L Produced
roduced V
(Signatur ��fe Qf RUj ) (Signature of Notary Public State of FI ri
Public F IELSEN.
o,P state of Florida-Notary0 484 `tiPuu,e KAR_N(ZS ,
Commissi •= Commission #G
� � }es Commission No. pYPp°' to of Flo ++Z P otary Public
My om ission _ ._ Commission#GG 207484
ii9�POF F��P�� June 12, 2022 ;�. a; ommission Expires
June 12 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS I VEGET E
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DATE
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DATE
COMPLETED
Rev.