HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST'BECOOMPLETED FOR APPLICATION TO BEACCE PTM
Date: 3 -t \ Permit Number.
s- - RECEIVED
• —
Building .Qers-itApoi do MAR 0 8 2019
Planning and Develop-mentServices ST. Lucie County Permitti �
pudding and Code Regulation Division
2300Virglnla Avenue, Fort Pierce FL 34982
Phone- (772)462-1553 Fax-,(77Z)462-1579 Commercial Residential X
PERMIT APPLICATION FOR To Select from dropbox, click arrow at the end of line
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Property Tax ID #- �7 X-
Site Plan Name: P [
Project Name:
Setbacks Front Back:
RightSide_ LeftSfde.-
Lot No. i
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
UHVAC UGas-rank UGasPipingUshutters 12windows/Doors
OElectric �Plumbing
/1 pO Sprinklers nGenerator Moot ( Roof pitch
in
Total Sq. Ft of Construction: V UO d Stt�Ftt of First Ftoor--/'2 S
Cost of Construction: $ OO O Utilities L�ISewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam--�W
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Name: .1
Company
Address: 12iU
City:
Zip Co e: Z)1=qK (Q Fax:
Phone No.
in state:
S
Addres. -�
I
City I r
Zip Code: 34gV—
Phone No.
state:-E7
Fax:T/2 R7R
E-Mail. t
Fill in fee simple Title Holder on ne
from the owner listed above).
age (0different -
E-mail: f
State or County License:
_Q-710
u rmuc v. wuauva.uvu o �—vua uw.u, a ncuunuru amouceor Wmmencemenr5requmw.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
Zip: Phone
Zip: Phone•-y ,State:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name-
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVI T: Application is hereby. made.tc obtain a.permitta.da the.workand installatioaas inclrated-
I certify that no work or installation has commenced prior to theissuance-ofa. 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 that
or and covenants 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[ 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 Commencementmay resultbt your payingtovicer 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 our Notice of Commencement
g tnh,f,A Ca L
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/LicenseRolder
STATE OF FLORID
COUNTYOF I h 1
r
STATE OF FLORIIM
COUNTYOF
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The falping instrument was acknowledg efore me
this %'{i)I�fi1,Y1 A
The forgoing instrum nt wa��55 ackkknoy ledgeSt�blefore me
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y f - 20 by
this � f fay o 20��/by
Cg I ( o f-ih
Name ofpe�rsojamaking ent
Personally
Name ofpers maldrgstatement
Known V OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced-
r
ur ota lic-S t on
."6.y 1HERINE HAVENS
to Of P blic-Sta[
On
,�a+P� HAVENS
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Commission ( �" 1 EX MISSION i/GG765030
- ��o EI(P�ES: DEC
Commission ,
t I �gKAATHERINE
."'ERN MIS610N aGG16503
flES:
04, 2021
�% DEC 04, 2021
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Bonded through 1st State Insurance
Banded through 1st State Insuranc
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REVIEWS
FRONT
ZONING
SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE --
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COMPLETED II
Rev.8/2/17