HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1-25-19ALL APPLICA LE IN O UST BE COMPLETED FOOMMICIBATION TO BE ACCEPT. ED q U
Date: 1 BSI �q BY Permit Number:
\ 3t Lucie County
- dqa l E =9 FTt:� RECEIVE®
Building Permit Application BAN 2 5 G019
Planning and Development Services
Building and Code Regulation Division i
S'j", I.Ur_je C-�17ty, Permittin
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 'i Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: �z
Legal Description: _
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Property Tax ID #: _
Site Plan Name:
Project Name:
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Back:
t,�,tiv Pn!'�5,PvE (P3 60-y,)
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Lot No.
Block No.
ght Side:— Left Side:
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Additl nal work to bje nertormed under tnis permit— check all apply:
VAC L_J Gas Tank Gas Piping _Shutters Wi doves/Doors
LJ Electric LJ Plumbing ❑Sprit klers E Generator _ Roof y ` �Z Roof pitch
Total Sq. Ft of Construction: S Z I S . Ft. o First Floor:
Cost of Construction: $ '400, OOy II Utilities: _ Sewer Septic Building Height: 311
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Name V �� F 7`� �%�/�N1�7�97ZbNlt
Name: V /3G�
Address: �7 7 c"> J w FZ,4 G f£� S T
Company: (%%31} e oo /S Li��G O 6G j',UG
City: State: FG
Zip Code: Fax:
Phone No. r12 — V /V9 y
Address: G�,7 � � DC 1J.c�,r�ISG Fs 01r IF
City: lL/1i` L �9,v DrAG E State: �G
Zip Code: � 3 � Fax: '—
Phone No.
E-Mail: Veld %Lm_6f*
Fill in fee simple Title Bolder on next page ( if different
from the Owner listed above)
E-Mail: (/O�J`�G Slaw
State or County License: e" G C O C/ 7Z g q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATION
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DESIGNER/ENGINEER:
Name: &( H7— 1N9
_ Not Applicable
/-1 SS Oc27,4-71ES,
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address IO 4 OML /),4
City: V C 12 O 6,6/AC j
Zip: 32 90 Phone '�
State: C
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City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY: ✓fVot Applicable
Name:
Address:
Address:
City:
Zip: Phone:
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City:
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,
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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Now
Sign ture of wner/ Lessee/Contractor as Agent for Owner
Sign ture of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF `b�,14
COUNTY OF 7-) 9n!!X
The forgoing instrument was acknowledged before me I
The forgoing ins rumen was knowledged before me
this -1-S' day of n 11) �l. 20 13 by �
v I
X
this day of 20J by
-
Name of person aking statement
Name of}person making statement
Personally Known
Personally Known
Type of Identificati
Nev"I �1k - SUAO of Florid
Type of Identification ..��"" +. N1Ait1A DIA
Produced Notary F'umc - State'01 F
Produced �� 055017 i
com0lhsloe IrBt} 05
My 00". gross 11sc 13, 2020
Assn
I my COMM. gross We 1�
-_.IlW*d1kWp(NtWaJWvy.
elil �� L
�(iJ11i��e�% /%fi IosdbNroulllNtslo�
(Signature, -of Notary Public= State of Florida)
(Signature of Notary Public- State -of orida )-
Commission No. SrOI'7 (Seal)
Commissi No. OSSOI-4 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEAT1J�tTL$ ....;..MANGROVE
-
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17