HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l9' �' 10. Permit Number:
By
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rn,n
RECEIVED
Building Permit Applica ion JUN b 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Count FL
2300 Virginia Avenue, Fort Pierce FL 34982 yr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
Address: M i1 'gec-&—e,c., 'T— L
Property Tax ID #: y5\\- 5TJ\ - o3a.1 • UIYO- a• Lot No. \1,i
Site Plan Name: �6o\ Block No.
Project Name:.
DETAILED DES
a
CRIPTION,'OF WORK, .
CONSTRUCTION INFORMATION:
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: `7 (i O Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height: -
"dW 'ER/I.ESSE�
Name
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Name: '�.D 94!Ct
Address: `4, _
Company: c'M��tlr� ®tY123
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City:
State�K L
Address: !Atrb �fil�3VSirt-tics`,
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Zip Code:'i3�� Fjn Fax:
N `1A
City,
State-�,
Phone No. 1iD-94k
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
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from the Owner listed above)
State or County License
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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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW WFORMATION
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: a State:
City: State:
Zip: Qk Phone -gj%@ -e33—W5
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,
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 FIRST INSPECTION. IF. YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL DLA
4�`C
STATE OF FLO�IQA�Ue
COUNTY OF e_� 2..
COUNTY OF
The fo going instrument was acknowledged before me
The for oing instrument was acknowledged before me
this day of m,�,�-cam , 20)a by
thiso'i� day of 20)F1 by
Name of person making statement.
Name of person making statement.
Personally Known
Personally Knownk_,�
P.
T e of IdentificationFi
Type '•STELLA M HUNTER'
Type of Identification ;►f °�" STELLA M HUNTER
YP c e•Produced
;_�^=
Notary Public • State of F,ilrida
Produced Notary Public • State of Florida
ommission a GG 281C:2'
My Comm.xoires Jan Z3. 2023
:9� y missioPn # GG 281062
,ocF�,: M Comm. Ex ires Jan 23, 2023
anded thi oLgh National Notary Assn.
Bonded through National Notary Assn.
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
ev. 217/3.9