HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '- L Permit Number:
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SCANNED
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o St. Lucie County
RECEIVED
Building Permit Application MAY 16 2019
Planning and Development Services
Permitting Department
Buildingand Code Regulation Division
9
St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial LeSicle17t18l
PERMITTYPE: S
PROPOSED IMPROVEMENT LOCATION'S
Mddress, ' ®D
Property Tax ID f#:
Lot No.�
Site Plan Name:
Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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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 Pitch
Total Sq. Ft of Construction: Sc: Ft. of First Floor:
Cost ofConstr�"�t(ct rrfb$��_�-3'— Utilities: _Sewer _Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S4Lt6 T W,( ii Name:
Address:9-&o0 0 Vf tQd h,=E Company:'
(City: T R r e A R e State; �. 'Address:
: Zip Code: 21I6i q 5 Fax: City:
State:_
Phone No. %� 7 1-/Gd 33Y1? Zip Code: I
Fax:
E-Mail: San4 0 okr-4-- n r^- sN • o awe Phone No
---o
I—�
1
4ill in fee simple Title Holder on next page ( if different E-Mail
(pcarLt i
from the Owner listed above) State or County License
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not App
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: , _ Not Applicable
Nama�
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
City: I city
Zip: Phone: Zip:
_Not Applicable
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
w.r" vn.m . euncn nR AN AT OpNov RFFnRF RFrnnnrNG YnuR NOTICE OF COMMENCEMENT."
Signature of owner/Lessee/Cohtractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID t
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STATE OF FLORIDA
COUNTY OF C A_C i
COUNTY OF
The for ing instrument as a k o ledged before me
g ��)N�
�y
The forgoing instrument was acknowledged before me
this day of 20_ by
this of �Oy
�P.rft
_
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifion
Type of Identification
Produced /
//��/� (1t' (I�/^' Psi
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Produced
(Signaltrre ofNotary P is -State
of Notary. Public- State of Florida )
ELLEN a-
Commission No. _+° State of Florida-N
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tWy.,P.4A�yp
�2277UU6677'' n No. (Seal)
_. •= Commission k G
`-? My Commissic
P;
Expires
REVIEWS
FRONT
ZONING
SUPERVISOR
FLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
Rev. 2/7/19 /