HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED jj ((�� ((��yy�� ^t I
Date: 51ZOlT— Permit Number:. 1g05.o 1(P
MEN= SCANNED
BY
. St. Lucie County
Building Permit Application
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 Residential
PERMIT TYPE:
Address:
RECEIVED
MAY,•Q 0 1019
Permitting Department
St. Lucie County
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Property Tax I D #: I H 119 - 2.11- (DO ZO - ow - n Lot No.
Site Plan Name:
Project Name: _ U( MAr 112 lkeoicX s}}ED
Additional work to be performed under this permit— check all that apply:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 114 b Sq. Ft. of First Floor: IQ to
Cost of Construction: $ _ 9, 9110. 010 Utilities: _Sewer —Septic Building Height:
DOWNER%LEES E
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CONTRACT0R'
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Name ��uV
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Name: V:Cb ONN(f QWWer Qa=�
Address: 51-7H 'T2EE TbP 7r112�L�
Company:
City: fT. Plo✓Ce. State:-L
Zip Code: Yqq.-1 Fax: 772 • q1 Lj •OzzZ
Phone No. 77 Z. - 61 $ - ,3 467 7
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: �D�+1IeJ�A•5oN¢� .
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.
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SUPP�LENIENT%ALC®N5TRUG^TI®N:LIEraTSss�iMEMy�pIN�FQRMATION
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DESIGNER/ENGINEER:
Name:
—/ Not Applicable
MORTGAGE COMPANY: ✓ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
r� Not Applicable
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 thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an 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 OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Less/Con s Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _t+ �-u-cx-e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 7day of MV 20 19 by
this _ day of . 20_ by
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Name of person making sta ment.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 1
Produced
(Signature of Notary PubLEEN I MCSWAI(Signature
of Notary Public- State of Florida )
r My COMMISSION # FF0358
f-F935SeBi�SNovemher78,20f
1
Commission No.
Commission No. (Seal)
l40/13980+53 FbfiCaNttm 9avkJ.bom
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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