HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll AP� NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-Date— 2I - - ---_ _Permit Number: �Q1ao't-� I lq
RECEIVED
•
Building Permit Applicati n FEB 0 7 20A
Planning and Development Services sr. LUE�e ESNn�, t'ermlrtln�
Building and Code Regulation Division
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential CANNED
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PERMITTYPE: • Q _ tw<� St. Lucie County
PROPOSED INPROVEMENT LOCATION:
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Z
Address: b7L! 0'
/ r7
Property Tax ID #: Ia) 561 Cval 1 -3 �il-JlJ3 Lot No.�-lJ 4 O
Site Plan Name: ' e L' V r Block No.
f'-V
Project Name: - D6/ 0' U I r
DETAILED DE 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 3 f a Pitch
Total Sq. Ft of Construction: —1 co Sq. Ft. of First Floor:
Cost of Construction: $ Z�SS Utilities: _Sewer _Septic Building Height:
,OWNERAESSEE:,
CONTRACTOR:
Name I
Name: Y
Address:
Company 1
City: State: V—)
Zip Code: 9 — Fax:
. Addres
City: Kf±vlcyaStater
SUPPLEMtNTAL CONSTRUCTIOWEI'EN LAW INFORMATION: U
DESIGNER/ENGINEER:- _Not Applicable_ — -MORTGAGE-COMPANY: _ NotApplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
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; vour Notice of Commencement.
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Signature of Owner/ Lessee/actor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLO�
COUNTY OF q , UG l 1
War,
COUNTY OF I�rj
The f oing in ent was a cnowledg efore me
The fore ng instr ent was acknowledge fore me
this�dayO� 20Vby
this of 20Vy
Name of p rson ma`g statement.
Name of person makiingstatement.
Personally Known V OR Produced Identification
Personally Known V/OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature ofNzWFy Pu rc-
KA EBINEHAUENS
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�"'L IEfiINEHAYFNS
Commission 5 �
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"SSION#GG165O30
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Commission EVO
=°% \�" ryry1tYCOMMISSION#GG165030
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Bonded tluuugh 1st State Insurance
� Banded through 1st State Insurance
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DATE
RECEIVED
DATE
COMPLETED
Kev. 9/26718