HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI
Date:
LE IN4O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
SCANNED Permit Number: ��d �A- day a
!, BY
St, LucieCwty RECEIVED
Building Permit An lication
J p AUG 0 9 anq�
Planning and11 l Development Services
Building and :,ode Regulation Division ST. Lucle County, Permitting
2300 Virginia(Avenue, Fort Pierce FL 34982
Phone: (77 ) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line M,,,,,,\
Address: 'I J1 AJ c JjJL .A
Legal Descriptiion:
Property Tax IID #:
Site Plan NanileI.
Project Named
❑HVAC
❑_ Electric
Total Sq. Ft of
Cost of Constr
Back: 'J Right Side: J
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OM
Left Side:
-K to oe errormea unaer tnis permit— cnecK aii apply:
0 Gas Tank ❑Gas Piping _ Shutters
0 Plumbing Sprinklers ❑ Generator
'onstruction:
Iction: $ y. 0(J
S Ft. of First Floor: _
UtilitiescnSewer ❑Septic
Lot No.
Block No.
❑ Windows/Doors
❑ Roof Roof pitch
Building Height:
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City:
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Zi,p Code:
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Phone No.
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Zip Code,-, Fax:
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Title Holder on next page( if different
E-Mail:o. (16)
State or County License:Gew-KO6(04
from the Owner
listed above)
IE
IT varue of construction rs }z5ou or more, a RECORDED Notice of Commencement is required.
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DESIGNERIENGINEER:
Name:
Address: II
City: II
Zip:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Y
State:
I Phone
I
FEE SIMPLE
Name: 11
Address: 11I
City:
Zip: I
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TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
1I
Phone:
I
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 Count 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. Plea�e 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 Ibiuilding 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 YO 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
befoqre the fIst inspection. If you intend to obtain financing, c nsult with lender or an attorney before
0pimencing, wqfk or recording our Notice of Commence t.
Signaturr�f
Owner/ Lessee/Contractor as Agent for Owner
Yignature Contractor/License Holder
STATE OF FLORIDtAdw
OF
STATE OF FLORJ.�ACOUNTY
COUNTY OF I 1 ll�Q�i��C
_
The forgoingn
ent was acknowledged before me
The f oing inst ent was acknowledged before me
this da
10201kby
this day of LL04 20�a by
Oq�.Pyr
i�C�
Car �� e
We
Personally Kr11own
e of perso making statement
OR Produced Identification
Naof person making statement
Personally Known i/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of
Notary Public- State of Florida)
(Signature of Notar
Public- State of Florida )
'Commission
Commission No.
<�AYP�'' BEV L AD D
;'��' Vic- II qq��
=,. Y COMMISSY �V 6G 009363
No
B BEV L. H g
�• ��; P
COMMISSIONMY # GG 009363
f• o`S EXPIRES: July 6, 2020
,'�iFDF F,OPp Bonded Thru Notary Public Underwriters
=; o; EXPIRES: July 6, 2020
.r
''�FOF; ;2•'' Bonded Thru Notary Public Underwriters
I
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
iDATE
(RECEIVED
'DATE
�1
COMPLETEDI
te'v. 8/2/17