HomeMy WebLinkAbout1911-0102 BUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNEDPermit Nur
BY
St LUCle COUrlty
_.__._...._.__._.... _..._M......-.._. Building Permit Appl
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
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NOV -6 2019
Cl ting Department
St. Lucie County, FL
Residential
PERMIT TYPE:
.a "xxrJiilili I�,tpa,
Address:
Property
Site Plan Name:
Project Name: _
i
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —.Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 3, q_�-y Sq. Ft. of First Floor:
Cost of Construction: $ l� �� 0, 0'0Utilities: _Sewer _Septic
Block No.
Windows/Doors
- hoof Pitch
Building Height:
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Name:
Address: A(1D S W r i�iye
Company:
City: ��G y `�r� Sttatter/q
Address:
&
Zip Code: Fax: T
City: State:
Phone No. v
Zip Code: Fax:
Phone No
_
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
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.
... `^,r.. " •" to ..hi,- `...
DESIGNER/EN�NEER _ Not APB'
p_,cable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address: _ _
_
Address:
City: o State:
City: State:
Zip: _' Phone_ I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I
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 Counter makes no representation that is gr I nting 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,i 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 FIRST INSPECTION. IF YOU INTEND TO, OBTAIN FINANCING, CONSULT
WITH,YWR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sig re of Owner/ Lessee/Contractor as Agent f 'r
Owner
Signature of Contractor/License Holder
STATE OF FLORIDA � -
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing insdged efore
trument was acknowle20
me
The forgoing instrument was acknowledged before me
this day of by
this day of 20_ by
% C'14AP_.
Name of person making statement.
Name of person making statement.
Personally Know OR Produced Identification
Personally Known OR Produced Identification
Type'of Identifi ti
Type of Identification
Produced C
0
Produced
(Signature of Nly Public -State of Flori )
(Signature of Notary Public -State of Florida )
Commission No. AUDREY PRWPHREY
Commission No. (Seal)
t MY COMMISSION # GO! 300817
ni B)nded
Tfiru Notary Puf
uc Undern�ifers
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REVIEWS
AR6
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED