HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO M ST BEE OMPCei Lb FOR APPLICATION TO BE ACCEPTED
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Date: I �' �� J Permit Number:
W �'
SCANNED
RECEIVED
Y
i St. Lucie
Building PermiMoplica ion
NOV - 8 2019
Planning and Development Services
Permitting Department
Building and Code Regulation Division
St. Luce ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE:OF
OA�S
Address �� �l 0 Dca n r'-)/t % A 1.7e-
Property Tax ID#: <) 0-7 L9,'2 "GQ�3 (90 D�
Lot No.
Site Plan`Name`
Block No.
Project Name:
a A oaS I o o
n6
•O U O INO +O'
Additional work to be performed under this permit —check all that apply:
_Mechanical GasTank _Gas Piping _Shutters
_Windows/Doors
_Electric _Plumbing _Sprinklers _Generator
_Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �(2� D Utilities: _Sewer _Septic
Building Height:
W Ei p
Name eS' Name:
Address Company:
City: c G State: Address:
'
���
Zip CodeWg_v t L' City:
State:_
!Fax:
Phone No. � `1 la S ' Zip Code:
Fax:
E-Mail:. Phone No
_
Fill in fee simple Title older on next page (if different E-Mail
from the Owner listed above) 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.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDAVIT: Application is hereby made to obtain a permitto 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.
o-
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.;'
'Sign turelof- r/ Lesse ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /���
STATE OF FLORIDA
COUNTY OF �'/
COUNTY OF
The fo ing instrument was acknowledg before me
The. forgoing instrument was acknowledged before me
this Tday of IV. 20 by
this _ day of 20_ by
tr9t,)p17➢ .1-0 Nt S-
Name of person making statement.
Name of person making statement.
e/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of ation
Type of Identification
Produced i •
oil
Produced
(Signature of N 4tary Public- State of Flor a
(Signature of Notary Public- State of Florida )
Commission No AUDREY B.H M�FP EY +
rs`"'"•`ak:,
:�: YtOMMISSIO 300877 �''.�
Commission No. Seal
(Sea[)
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EXPIRES: March 6, 2023
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
FmRO T
ZONING
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.