HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMMMM LLETED FOR APPLICATION TO BE ACCEPTED /
Date: �' a z 1 q, Permit Number: 7 j% 3'y (PC r
SCANNED�*4ff -nQVT02-r5t-,� By RECEIVED
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ill St. Lucie C01-IMY
_.._ Building Permit Ap _ lica-UGHAR
_ 2 7 2019
-- - -
Planning and Development Services) Permitting Dep.rtment
Building and Code Regulation Division St. Lucie Co FL
2300 Virginia Avenue, Fort Pierce FL 34982 Yr
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial esl en la
Address:
Property Tax ID#:�(0
Site Plan Name:
Project Name:
Additional work to be performed under this permit -check a
mechanical _ Gas Tank Gas Piping x
V Electric —Plumbing —Sprinklers
/ A17
Total Sq. Ft of Construction: Sq{,! FI
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Cost of Construction: $ C7 'E Jtilities: C.
Floor:
Lot No.
Block No.
—Windows/Doors'
rRoof 9 1 • Pitch
;Sewer Septic Building Height:
(3WN/LESSEE'a: 'Ki3GbNfRTit
x �3 2,
Name S fie.
Nafrie:-• -,=__�
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Address:%All,
Company:
City:VA' 'Pi ievc-e. State: lk
Zip Code:3)A q 12)k fax:
Phone & --I %--) gam%
Address:
City: State:_
Zip Code: Fax:
Phone No
rN�6�'1 `Ci
E-Mail: • f i psl -S1-C a -lc S It Cn i )iA •Q Vl
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
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.
City:
Zip:,
FEE SIMPLE TITLE HOLDER:
MORTGAGE COMPANY:. Not Applicable
Name:
Address:
City: State:
Zip: Phone:
_ Not Applicable I 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 County makes no representation that is granting a permit will authorize the permit holder to build the subject st,Fucture
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
WITH YOUR LENDER OJb AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." '
grfau` e o af^ f Own'e� Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
! •.,•
STATE OF FLORIDA
COUNTY OFF
COUNTY OF
'9 •
The forgoing instrument was acknowledged befor
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me°•":.�..••''
The forgoing instrument was acknowledged before me
this day of: )77-R k-4W - , Of by
this _ day of 20_ by
Name of person making statement.
rP m
Name of person making statement.
Personally Known � OR Produced Identific
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
e`� n� A�t�YA—•
Produced
'
bi to
(Signature e o of Nebry Public -State of Flori
(Signature of Notary Public -State of Florida)
Commission No. (Seal)
Commission No. (Seal) r:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE '
'MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev. Z/7/19