HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a. Permit Number:a i0JS-4%SS
RECEIVED
.. _ MAY 04 2021
Building Permit Application F'arm1tt1,r9 Department
Planning and Development Services
S • Lucie County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential l/
PERMIT TYPE
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Address: 10 (O O C1 C�tzk l xo
Property Tax I D#: ��� a — aoS— 1� Lot No.
d Block No.
Site Plan Name: A t? h 1) t— ILA' I
Project Name: ll t 1
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Additional work to be performed under this permit—check all that apply:
Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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'Name 1. -'.Name:._ M, r)hrIP-1 �.�1.�� LAO
Address: lV1 tea
City: i P— CR State:
O State:
Zip Coder kcf St Fax: City.,
Phone No. RS —clv — Ll ZI CT Zip Code: Fax:
E-Mail: L 1 l— VtCO Phone No � �
Fill in fee simple Title Holder on next page( if different E-Mail �- J Y\sL 'Vh��A(4- _191M w
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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not-Applicable
Name: Name:
Address: Address:
State: City: State:
City:Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: .
City: City:
Zip:
Phone: Zip: Phone:
made to obtain a permit to do the work and installation as indicated.
OWNER/CONTRACTOR AFFIDVIT: Application is hereby
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 orpprY ibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
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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 YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER;OR AN ATT EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT:"
Signature of Owner/4eetractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S t COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgged before me
this day of �4��4� 20&% by this day of
20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificaon ^ Type of Identification
Produced
`� y L Produced
DEANNAGIVENs Signature of Notary Public State of Florida)
(Signature of Nota ublic- n a g
;'*aY vve
0 4�• Notary Public"State of Florid
Q• Sew mission+t{H086359 (Seal)
Commission NoAM*6-La'3 �s ( Ex Tres Jan 28.20 5 mmission No.
o My Comm. P As n.
•'••••of F`•••' h National Notary
Bonded
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
,COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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