HomeMy WebLinkAboutBUILDING PEREMIT APPLICATIONP ( �-e- V1
All APPLICABLE INFO MUST BE COMPLE1 efj iOR APPLICATION TO BE ACCEPTED
Date:' .5� Z,-S � 0, PermitNumber: \C1\t6_tq
SCANNED
BY RE:CEEIVE:D
St. Lucie County M Y
Building Permit Applica [ion MAY 2 3 2019
Planning and Development Services ST. Lwcio County, Perml:tting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Comrhercial ReS�d
PERMIT TYPE: TIN V_
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P
Site Plan Name:
Project Name:
Additional work to be performed underthis permit- check all that apply:
—Mechanical — GasTank — Gas Piping — Shutters
Electric Plumbing Sprinklers Generator
Total Sq. Ft of ConkrUaion: I . !;L� _1� to 44- Sq. Ft. of First Floor:
Cost of Constructijaa;x$---g Utilities: Sewer Septic
Lot No. —
Block No.
Windows/Doors
,�e, RMOTP'�- � PTCFN--b
Building Height:
R." ftq�/LIESSEE'
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ame L v.^�t _ J
Name:
ddress:_2S I ?� bL��U��c� L.�, YLJ
Company:
ity: %LJ State: At
ip Code: -'b I Fax: '7-) 7-4UF_-9=
one No. ')-17 - q (eit-3 '1'2 7
Address:
city: State: —
Zip Code: Fax:
Phone No
-Mail:
ill 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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(k L11b h hF.00 -7-7 Z4-7�� -2 C) — 9674
DESIGN ER/EN GIN EER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
City: - . .11 -
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
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 authori ze 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 restrietions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, per -form thework
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 IMPROYEMENTS 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 13EFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
nignatiure of owner/ Lessee/C ractor as Agen�for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY -
COUNTY OF
OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of � 20_ by
this'�.�clayof .20 JA by
_
Name of person making statement.
Name of person making statement.
Personally Known OR Produced 1-dentification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced 14Z
(Signature of Notary Public- State of Florida)
Commission No. (Seal)
(Signature of Notary of F%MN MARII=UIVLN�
IISION#GG022023
EX -%D MW16,2020
G6
Commission No. ondei � r2blUnderWitem
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19