HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dates "� 15' 19
CANNED Permit Number:
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CEIVED
St. Luriprnlin
Building Permit Applicat
0
Planning and Development services
Building and Code Regulation Division ounty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
PERMITTYPE S'� R
Address:
PropertyTaxlD#:J3(�/
Site Plan Name: + Lot No.
Project Name: 96R Wac Block No.
dGtJN�L9 h-r IG�CS r .,.i.ay �
Haaitlonal work to be performed under this permit— check all that apply:
(/Mechanical _ Gas Tank Gas Piping _ Shutters /
-/ �/ Windows/Doors
�ectric ✓PI �I sprinklers
Generator Roof s' / Pitch
Total Sq. Ft of Construction: F , L-r I/l
_ Sq. Ft. of First Floor: S, t-9
Cost of Construction: $ �S'�O�ypp, r"r�Sewer4L��j
Utilities eptic Building Height: I'S%OQ y
ate J' {�•�+ �a
veu Company:
City:
Stat-
Zip Code: Ag9S•/ Fax:
Phone No. :"( y
E-Mail:�64,,�g� r .SSd'eyepI. four
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
City;
Zip Code:
Phone Nc
State or County License
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is rec
If value of HVAC is $7,S00 or more, a RECORDED Notice of Commencement is required.
Fax:
State:
z �4�4� i�4{S '1h 8
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DESIGNER ENGINEER: Not A Fli
Name: �/ (v. £ ?A G /tl
abl
MORTGAGE COMPANY:
Name:
Address:
_ Not Applicable
Address. / vcv 7 !/.c
City: a State:
zip: _ Phone. aC;'_g7^ ez.sz
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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 ER 09.M ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
Signature of ne
essee/Contra for as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The foing instr ment was acknowledg2efore me
The forgoing instrument was a nowledged before me
thisdayof.YX
by
this _ day of 20_ by
y,iiN
w)mkj S)�!.
Name of person making statement.
Name of person m Ing statement.
Personal) nown
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OR Produced Identification
Personally K wn OR Produced Identification
Type of I enti ion
n`
Type of Id tification
Produced
(JL Y �1,
Produc
(Signs ure of Notaky
public -State of Florida
(Signature of Notary Public -State of Florida )11
Commission No.
:'�?°"'••: AUDR UMPHREY
COM� k GG 300817
Commission No. Seal
(Seal)
.+o EXPIRES: tdamh 6, 2023
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