HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO U�SjT BE CCi ',-={.ETED FOR APPLICATION TO BE ACCEPT E
Date: 13 I 1 Permit Number: �q O )'-cl
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Building Permit Application FEB 13 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 _ --
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: ]V 1 SCANNED
PROPOSED
IMPROVEMENT
LOCATIONt
Address: OD 3' 1 VL(U of ki WA VQ-,
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Property Tax IDM I— ���— 660EQ00'0) Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONS UCTI N INFOR ATION:
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters — Windows/Doors
X•j:lectric Plumbing _ Sprinklers - Generator - _ Roof Pitch
Total Sq. Ft of Construction: r Sq. Ft. of First Floor: '
Cost of Construction: $ 500D c5D Utilities: Sewer _Septic Building Height:
OWNERJLESSEE:
CONTRACTOR:
Name
Name: 8LUctin,1- 13W
Address;-1-1003 � r 1
Company: -
Address:
City: ff✓ i0I eA Cz_ Stater
City: State:_
Zip Code: 3q�C- Fax:
Phone No.
Zip Code: Fax:
E-Mail: -f-
a-.YiG8t
ne No
Fill in fee simple Title Holder on next page (if differ t
E-Mail
,State or County License .
from the Owner listed above) •
i
If value of construction is $2500 or more, a RECORDED' Notice of Commencement is• e4uired.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required:
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1
SUPPLE EN AL CONSTRUCT LIEN LAW INFORM
T E)l
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
"YARNING 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 PEFOPE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LEINDER pR A TTO NNET BEFORE RECORDING -YOUR NOTICE OF COMMENCEMENT."
a as ent for Owner
Signature of Owner/ Lesn,)n.,�
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTYOF_ .
COUNTY OF
The fing instrum as acknowledge before me
or o
this day 20 f by
The forgoing instrument was acknowledged before me
this day 20_ by
of
_ of
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Name of Orson making statement.
Name of person making statement.
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Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L
Produced
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(Signature of Notary Public
ignature of Notary Public- State of Florida )
KAREN S. NIELSEN
4PAY P4Ay
Commission No. ;+° k StgSeQI)Florida-Notary Publ
o pmmI5510n No. '(Seal
- •= Commission # GG 20748
My Commission Expires
ZONING
SUPERVISOR
REVIEWS
FRONT
PLANS
VEGETATION
SEA TURTLE.
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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