HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /1 '
Date: z% �� % �- Permit Number:
SCANNED
BY
RECEIVED
�. St. Luce Couro
s
-- Building Permit Application NOV 12 2019
Planning and Development Services Permitting Department:
Building and Code Regulation Division
St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 7� Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT
LOCATION:
(Address: 0
o Property Tax lD #: ivJS`' 7,01 616 7-49212 7 Lot No.
Site Plan Name: _kiS , --S Q5 Q� Block No.
Project Name:
DETrA'ILE-D DESCRIPTION OF WORK:
o✓ Sp /�✓ e ��✓ GeJpl uy
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CONSTRUCTION INFORMATION:
i
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: Sq. Ft. of First Floor:
ko // CO
cost of Construction: $;512 Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRAC OR:
Name r r
Name: 4 to 614
Address: ` it
Cfompany:La r I GAL !fe .c,.
c`
City: / ( e4 66'M State:/�-r
Address: 9 D
City: 9 / e2/-e-r r State
Zip Code:_ Fax:
Phone No.
Zip Code:3 V !¢cf'l Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail &Ctr& cot,
from the Owner listed above)
State or County Li ense �- 00 3 3
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.
SUPPLEME_N LOONS
RUCTION I=NLA
NFORM
ON:
DESIGNER ENGIN :ER-
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: t
_
Name:
Address:
/
Address:
City: Jlee G
Sta e: r%
City: State:
Zip:929Go 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 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 IMPROYEMENTS 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 t Vf Owner/ Lessee/tF,actor as Agent for Owner
f Contractor/License Hoer
ig ZOF
STATE OF FLORIDA
STA FLORID /
COUNTY OF ` � ��
COUNTY OF
The fqqr oing instrum nt was acknowledg efore me
I� � �1%
The for oing instrument wa acknowledg efore me
/Nay
this day of • . 20V•by
this of ,�i(` , 20� by
k0 zaT�-)19
4-P it �h�l
1
Name of person making statement.
Name of person making statement.
Personally Known ` OR Produced Identification
Personally Known l OR Produced Identification
Type of Identification
Type of Identification
Produced •
Produced
(Signature of N u lc -,State of Florid
(Signature of N to Public- State`of Florida' _
;•ies'rr,'y"••„%• ANREYB1� Iyff�HREY
Commission No. 0 ](G
• '., OMMISSI G30081b
Commissio p.•••••.,
,AUBREIF B. HUPv1PH
•.••
_ P EXPIRES: March 6, 2023
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: s `r : MYcOMMISSION 4 GG 300817
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REVIEWS
SUPERVISOR
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REVIEW ro
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.21i/iy