HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'm Permit Number:
SCANNED
BY
St. Luc'P coubty
Building �ermit Appl
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
PERMIT TYPE:
P OPOSED IMPROVEMENT LOCATION:
SEP 2 3 2019
ermitting De p tme
St. Lucie C nty, FL
Residential
Address: 01$3 AI&YV,V4 d4,
Property Tax ID#:II yl (—?0/-0/3y--Odl}—s Lot No.
Site Plan Name:
Project Name:
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank ' _ Gas Piping _ Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: ® 5, 0o Sq. Ft. of First Floor:_
Block No.
Windows/Doors
Roof Pitch
Cost of Construction: $ ® �-O , DO O Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
/
Name rr)
Name:
12-o
Address: -5'Y 7 iftlN z&.
Company: - LG1
o J.
City: 161N . ./ ^ iC'? State: %,
Zip Code: �fl Fax:
Phone No.
Address: L)fb '16h11 G -lei W
City ° 2 /
Zip Code' jY / 5
Phone No 7 7
Stater
Fax:
U
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail " rrLrrrL�.
� s ��� �i �Jd!^� �• 441
State or County Lit`ense
C ig
If value of construction is, Z500 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.
UPPLE-MHNTAL CONSTRUCT ON L
NFOR
A I@
DESIGNER%ENGINEER:
Name: Z1l
Not Applicable
cei#✓x
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: otceo
A Sle"
Address:
City: C rz w,S&
Zip:_, Phone
State: NJ,
77Xf
'`
City: State:
Zip: Phone:
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 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 YOURX-E- WER.OR-AN ATTORNEY BEFORE RECORDING YOUWNffT—IZEAF COMMENCEMENT." '
A/M
/ Lessee/Contractor as Agent for Owner
SignaturrFLORrDA
Signature tractor/License Holder -
STATE , I. _
��
STATE F FLORI 1 )
COUN
COLIN OF
T�oing instr ent as acknowledge efore me
The fgZgoing instr ent was acknowledged before me
t day ofQ . 20 by
thi day o2021� by
-
Name of person rhaking statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known __�rOR Produced Identification
Type of Identification
Type of Identification '
Produced
Produced
p
(Signature of Not Public-Sta
(Signature of Not r Public -State of Florida
...i ••., AUDREY B. HUMPHREY
Commission N '• MISSIo 300817
Commission `AUDREIs B
m� --?<; EXProh6,2D23
IRES:Ma
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ISSO1��817
I N
March 6, 2023
61rxriters
EXPIRES:
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SUPERVISOR
PLANS
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MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED'
DATE
COMPLETED
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