HomeMy WebLinkAboutappAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _.� �� \o'� _
Permit Number.
•
F—RECE—[V—F—D�,
Building Permit Application Jill T ?
Planning and Development services
ST. Lucle Cuuncv r•,,,,,,�,r, t
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential_
PERMITTYPE: Ii
Address:
O P.
Property Tax ID#: /Yq3 S/` q-C11I-000-'t
Lot No.
Site Plan Name:
Block No.
Project Name:
b
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: 4 ?C�)
Sq. Ft. of First Floor:
Cost of Construction: $
Utilities: —Sewer Septic Building Height:
Name C� C r
Name: I
Address:?O23 (� 1 a5T
Company: f
City: '�
State! Address:
Zip Code: Fax:
City: P State:
Phone No.
Zip Code:ng_�-,(' Fax:-772-Y4[-4f
E-Mail:
Phone No%7 - /,6 27 1
Fill in fee simple Title Holder on next page (if
different E-Mail ria:4i lV 2)
from the Owner listed above)
State or County License a, ell g 5
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.
DESIGNER/ENGINEER: Not Applicable
MORTGAG E CO M PA NY: Not Applicable
Name:
Name:
Address:
_
Address:_
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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. 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
WIM YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOOR NOTICE OF COMMENCEMENT."
U AIJ U&17-
Sin ure of 0 ner/ Lessee/Contractor as Agent for Owner
signal o Contr ct icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
S �-ut
COUNTY OF &,i, X-:Qr %Q
COUNTY OF • sQ
The forgoing instr ment was acknowledge before me
The forgoing instrument was acknowledged before me
'5
this day of ON3 , 20�A by
this \ day of \1 \''. , 20A by
�r.2,c�� J4i°►�eS
bra r�•.s .�a..iie.c3
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L.
Produced
(Signature of Notary P lic- State of Florid -
(Signature of Nota Public- State of FlocidaLr�:
MARIE GNENS
Commission No. DFANNP _ij"1#GG 022023
DE�pry IplgblpREGNENS
Commission No. CGMMISf�G 02020
Y CGMN
r •�•= ExP,R. December 16, 2020
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'�; EKPIRES: December 16, 2020
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REVIEWS
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SUPERVISOR
PLANS
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SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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