HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:-JCQ'2,� iq Permit Number:,qO
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
'1 I ll,ed tQr& - RECEIVED
Building Permit Application JUN 2 0 2019
ST. Lucie County, Permitting
Commercial Residential C/
Address: 6/ (� �7� PIPS %7B"4w 4-P — S-11—AWN—ED
PropertyTaxlD#: BY Lot No.4�—o
Site Plan Name: St.Lucie Cou Block No. QB
Project Name:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
Electric _Plum�7bing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: /S C G
Cost of Construction: $
T
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name
Name:
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Company:
City: O r t a r C1p
Zip Code: 0i LfS - Fiax: "
Phone No ..,... !AL Z . o
la,Address:
State:
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Address: GL
City: �� State:
2ip'Coiie: 6 Fax:
Phone No •2. 2 .5�-.6br .
E-Mail 00Q c91jCC9
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Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail D N Cr2 9y e
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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Name:
Not Applica le
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Name:
• •Address:
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City: -State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
---
BONDING COMPANY: Not Applicable
Name:
Address:
• • -
city:
City:
• •
•
OW NER/ 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 Count 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 appro,Qed"Arcs, 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 LEADER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Own / Le ee/Contractor as Agent for Owner
Signature of o tractor/Lice se Holder
STATE OF FLOR
STATE OF FLORIDA I
COUNTY OF .4.
COUNTY C JFA
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 0(o day of � � , 20_1y by
this QL day of 24 , 20-j by
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� V I ID es
Name of person making statement.
Name of person making statement.
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification V
Type of Ident io -
Type of Identi tion
Produced
Produced
11�1• �—
(Signature of Notary Pubbc-State of Fl&rica)
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(SigKgRrLeNf�lo rEL - a', S NIELSEN
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'o'c State of Floritla-Notary u r,„ `' pubbc
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Commissio Np nr'nJ'., KAREN S. NIEL�I N
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IVED
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