HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: V:N(os - ou qa-
SCANNED
BY
St. Lucie County
Building Permit Application 06
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 VZ
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=PROPOS E QJ
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Address:-& Cr- L A tN D f+ VC- F
-70(
Property Tax ID #: Lot No. S-4-(,
Site Plan Name: Block No. 1 ;2
Project Name:
111DOTAl LIE DIOESGRI WOO NIO§U@ R
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Additional work to be performed under this permit -check all that apply:
-Mechanical - GasTank Gas Piping Shutters —Windows/Doors
ZElectric - Plumbing -Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ YOO&Sa- Utilities: -Sewer _Septic Building Height:
MONERVIESSE
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Name 1RNL(>%`l7 F, Fosven,, J(L
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Name:
Address:- (970(o Dc-i-F�r4h Noc-
Company:
City: F L) RT- P L C-fzc r- state: CL
Adcl�ess:
City: State: —
Zip Code: 3�fcfs,i Fax:
Phone No. T7.1
Zip Code: Fax:
E-Mail:-
Phone No
Fill in fee simple Title Holder an next page if different
E-Mail
from the Owner listed above)
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.
DESIGNER/ENGINEER:
Name:
Not Applica-ble—IFORTGAGE
COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: _ Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
—Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTORAFFIDVIT: 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 permi - t 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
(2 q4��� '
Vignature of l9wner/ Le(jse/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 1�411.xe;
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of 20_ by
��o �h U4'cg�
this _ day of � 20_ by
Name of person making statement.
Name of person making statement.
Personally Known -OR Produced Identification
Personally Known OR Produced Identification
Type of [dent
Produced
Type of Identification
1�� R�:t�
Produced
(Sieatult of Notary Public- Staf% of Florida
(Signature of Notary Public- State of Florida
Commission No. LAsHmmAiNr.RAM_RAHMING
Commission No. (Seal)
W M cNMIS ION# GG275060
Y COMMIS
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DATE
COMPLETED
Kev. 21 // 19