HomeMy WebLinkAbout1910-0457 BUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 Permit Number: 1 `�a
SCANNED
BY
ii St Lucie County RECEIVED
R � OCT 21 20'9
Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V Residential
PERMITTYPE:
PROPOSED NOVENNAWLOCATION:
Address- Die U
Property Tax ID #: Lot No.
Site Plan Name* - Block No.
Project Name:
D TAl'LED DESAWAPTION O ORK:
6 e- C r
Ll
CONSTRUCTION l'NFO'R, ATtON:
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: $ t0,(D0Cfc' Utilities: —Sewer _Septic Building Height:
POW NERJLE55EE.
CONTRACTOR:
Name
Name: 2 1
Address:
-City: _(4 MW State:?'T'
Zip ,Codee: c� J'• : Fax: �2�
.. ,:. ,:.
No1
Address:
City--:' Stater
5 _
ax:Phone
Phone No 72A � — 0
E-Mail:
Fill in fee simple"Title"Hol"der on next page ( if different
E-Mail -5 f GA CMG
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.
5
DESIGN ER/ENGINEE •
I Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:�)���� �(�
Name:
Address'
I Address:
City: '( TrL
I State:_ -City: State:
Zip: ?� Phone
i Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY: Not Applicable
Name:
I Name:
Address:
I Address:
City:
City:
Zip: Phone:
I Zip: Phone:
OWNER/ CONTRACTOR AFFIDVI�: 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 Ho I e 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,lthe 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 FAI IURE 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
WIMYOURJZNDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature Owner/ Less ee/Contracto'r
as Agent for Owner
License Holder
i ature o C tSTATE
STATE OF FLQRI
OF FLQrracto►r
COUNTY OFF I I
COUNTY O1` }'V .
The f rgoing inst u en was acknowledged
before me
The forgoing instrument was acknowledged before me
this day of
?Oa by
this _2L day of CrJtUff 20J�_ by
,ii('1�1C lcd A . l=
asp- KJYf++
Name of person making statement. I
Name of person making statement.
Personally Known V OR Produced
Identification
Personally Known V/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Signature of No ry Pub ic- t e
of Notar ublic- tate of Florida )
ASHLEY FOSTER
'State of Florida-N
�y ��.��.,,
Commission N b 4Q11
t � � n No
FO
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i �= Commission # G
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My Commissio
t 2 4 �,a�V;�a,, ASHLEY
Expires %State of Florida -No
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My Commiss,o.n
REVIEWS
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MANS 20'
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REVIEW
REVIEW
REVIEW REVIEW
R
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DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19
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