HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Npl, Kermit Number: u ` U/lN
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LudecoUl* RECEIVED
Building Permit Application JUG ®8 2019
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
PERMITTYPE: `I
Address: `LC�O
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Permitting Department
St. Lucie County
Residential
PropertyTaxlD#: �Zs-(�c�S�003( (J��- C7 Lot No.
Site Plan Name: Block No.
Project Name:
Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _Shutters
VElectric -L/Plumbing _Sprinklers _Generator
_ Windows/Doors
Roof
Total Sq. Ft of Construction: ) 0 D Sq. Ft. of first Floor:
Cost of Construction: $ 10, 0-0b , 'J v Utilities: —Sewer _Septic Building Height:
Pitch
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OWNER/LESSEE:
Name O''/6J
CONTRACTOR:
Name: o Sb Ves
Address: 200 JV C✓
"�t % CA -It
Company: (:, (zeCr
vc"'?/L
City: ET e r� 1 - 3 State:
Zip Code: 3. �4 9 9 (Y Fax:'`.' , ,
Phone No. i
Address: 3 V 3 Z SLL) E-)
M f e 3?f'
City: �S �-
Zip Code: 3 S S 3 :Fax:
No
State:-E�-
z
E-Mail: .....Phone
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail rP Sam i<
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State or County License
2
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.
UP LE @N L CAN
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DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
I
—Not Applicable
MORTGAGE CO P _ Not Applicable
Ni
Address:
State:
City: one: State:
Zip: R
FEE SIMPLE TITLE HOLDER:
Name:
_ 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 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA S(� ( , ,
STATE OF FLORID
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COUNTY OF Cii �
COUNTY OF Cl�l C (J✓�
The for oing instrum t w s acknowledged before me
this day of 20 (A by
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The forgoing instrument was acknowledged before me
this day of �, 20 /4y
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
( t
Produced
Produced
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(Signature of Notary Public -State of Florida)
(Signature of Notary P blic-State of Florida)
Commission No. EN VAUGHN
mmission No. .�``y�^y;', ELl(.
;� _State of Florida NotaHN
State of Florida -Notary Pub
isIII ;y Cpmmissio y Public
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