HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLL..'D FOR APPLICATION TO BE ACCEPTED 'D i
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Date: SCANNED Permit Number:
BY ECEIV
St. Lucie County
• SEP 26 2019
— Building Permit Applica iP}mitting Department
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: _.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: �tiG--)elt V
PROPOSED IMPROUEM@NT LOCATION:
ddress: -5 AMWW9 /
Property Tax ID x. �a� �,' )A 513,19 1-- 0 d. _,-__ - Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED OESCRIPTION OF WORK:
COP
--Vr2re
CONSTRUCTION INFORMATION:
_ .. .
Additional work to be performed under this permit -check all that apply:
echanical _Gas Tank _Gas Piping _Shutters"\ Windows/Doors
v Electric _Plumbing _Sprinklers _Generator Y-Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: I /1 b
Cost of Construction: $ o Utilities: _Sewer _Septic Building Height:
OW ER/LESSEE:
CONTRACTOR:
Name &
Name:
Address: i 4
Company:
City: State: lam/
Address:
City: State:_
Zip Code: -7 Fax:
-k
Phone No. %ii - W 1
Zip' Code:' Fax:
E-Mail:_-k!a� conifr 40 a a0 l rcoM1-,
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
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.
DESIGNER/ENGINEER: Not Applicable7MORT.sGMPANY:
Not Applicable
Name:
Address:
City: State:
State:
Zip: Phone
Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: IVot Applicable -
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: 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 makesno 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 Y R OR AN A OR EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."'
Signal< re of 0 r/ essee/Co tractor as Agent or Owner
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF �����
STATE OF FLORIDA
COUNTY OF
The f rgoing instrMent was acknowledged before me
thi day of_-_'i er'' • . 20)2 by
The forgoing instrument was acknowledged before me
this day of 20_ by
907Ne') 4414LL
Name of person rdaking statement.
Personally Known OR Produced Identification
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No YyPublic- State of Hori a)
(Signature of Notary Public- State of Florida)
Commission No. :::te"'••. AUDRC IIilGPHREY
Commission No. (Seal) -
_�` MY COMMISSION # GG 300817
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REVIEWS
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PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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