HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: \ONG
SCANNED
13Y CRECEIVED
St. Lucie County A
0 U 20ig
AUG 0 8 20M
Building Permit Applicat on
Planning and Development Services ST. Lucie County, permitt
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:
?R0 - POSEDIM�F�OVEMENT,�LOCATION-"
Address:- 67iq 0"ftAN U Fao-r PLI--Rcaz rl-
Property Tax ID #: 623- (,Jnw -000 - q Lot No. IZ-413
Site Plan Name:
Dool- Block No. q
ProjectName: lAej��j
bE'tAILl2b'btSCklRTlbN WORK:,
KAMM- IMINNOWWRI W11:009—PAT 11FIR1111111 WXWMWW1WWdM.
.CbNstRudTib'N INFORMATION:
Additional work to be performed under this permit -check all that apply:
—Mechanical — Gas Tank — Gas Piping — Shutters —Windows/Doors
— Electric — Plumbing — Sprinklers — Generator — Roof Pitch
Total Sq. Ft of Construction: /)?OD gr.,6:7-
Cost of Construction:$ /5' 0 0 0, L-)12-
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OWN I ER/�ESSEE:,'
-'CONT'RACT911:
Name
Name:
Address: _A7111 *P 71)z
Company:
City: A27- plwy'5r State:;?K
Zip Code: 99f&'Z Fax:
Phone No. 7zz- 37o--55� 2
Address:
City: State: —
Zip Code: Fax:
Phone No
E-Mail:
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.
Name: '4iaA2E omb-7Z
X ff
Address: /39' —t-5t_r 01�_WAV
City: VAi ft 4?&Qz.�t_6 State:
Zip: 2F2� r-3 Pho:ne
FEE SIMPLE TITLE HOLDER: )C NotApplicable
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants that ma estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions yhich may apply.
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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."
Signitur6of Owner/ Lessee/Contra sAgertforOwner
�P�
Signature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The oing instplent was ackn ow ledged before me
The forgoing instrument was acknowledged before me
this day of 20n by
this day of . 20 by
Name of person making state ent.
Name of person making statement.
Personally Known 4�� OR Produced Identification
Personally Known _ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig6ature of Notary P6blic- State of Florida
(Signature of Notary Public- State of Florida
.09y fte, KATRINAXLUCINEC
Commission No. MY COMMISS14N W3730
Commission No. (Seal)
EXPIRES: September26,202D
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I COMPLETIED
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