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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMi•Lt rED FOR APPLICATION TO BE ACCEPTED Date wT'©'m Permit Number: r" SCANNED RSCENED BY St. Lucie County APR:%,& VA DeplaBuilding Permit Application P G+tt1 UC Co �Nnt Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort.Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialy PERMIT TYPE: Address: /9 7_ nris( [�7 A«c� /%L 3 51QC/� Property Tax ID #: Site Plan Name: Project Name: Lot No. Block No. Additional work to be performed under this permit —check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors _ Electric _ Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ 7x�P? Generator Roof Pitch Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: OWNER/LESSEE: CONTRACTOR; Name Name: Address92 DG� Gycc_ Company: T City: %7 ��r P� State:/ L-, Zip Code: �;yf.YS— Fax: l " Phone No. 2 ^ —! 2 ,_Address:--.-. ............. _:.._.-... `Cityy State:_ Zip;Code:• - ;ca'<; Fax: Phoiie,No.n- >: E-Mail: n l_ 21.1.C4,Gaul- 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. SUPPLEMENT GONSTRUC LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable Name: I Name: Address: I Address: Zip: Phone: I 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 FAILU O RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPR9XWNTS,,TWYOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON TH SI EFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOU DER X401 RNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Signal e or er/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY COUNTY OF OF zbc L,,,r The forgoing instrument was acknowledged before me The forP,Ting instrument was acknowledged before me ay this day of 20_ by this day of ; 9 204 by )A ,% snth. .- V �"wnAII ._ Name of person making statement. e Name of person mallingment. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced (Signature of Notary Public -State of.Florida ) Commission No. (Seal) (Signature of Notary Public- State of Florida) V Commission No. n:'•, INGRAM• MING ..,• My COMMISSION#GG 75060 REVIEWS FRONT $Z S VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev 2/7/19