HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DaYe _�� _ p/ SCABN�NED Permit Number:
St. Lucie County
• _ --- Building Permit Application
planning and Development Services MAR 14 2018
gVilding and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL 34982
phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line <C/7J ode
PROPOSED IMPROVEMENT LOCATION:
Address: �D U100 / JEr� ✓� /— a%S�\
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Description: ���} l�� I
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Legal
Tax ID #: 13 I —� 703 - 0001 - O DO - Z Lot No.'
Property
site Plan Name: �r.FF6 Nf %C[:5l Block No.
�✓ Alz�i l SA%/'T l e4yo /i-TiOny
Pro)ectName:
setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�y�hFiaonl ov4�or,/ L--f(0 oulcilnly
CONSTRUCTION INFORMATION:
diona wor to e e orme under tispermit—checka apply:
�HVAC 11GasTank E]GasPiping in _Shutters Windows/Doors
Electric Plumbinggt ❑Sprinklers []Generator `L-1 Roof
, Roof pitch
Total sq. Ft of Construction: , uv S Ft. f First Floor: 1" 7 lX
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Cost of Construction: $ O 1 —o Utilities: Sewer Ll Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name E
-Address: 0 /�l �l noog a� #I o I --
City: F' �lkRCti State: Eh
Zip Code: 3N 9 J f Fax: dA
Phone No. Y15- A/YX" 7450
E-Mail: bQP.b� 47mCrl11A11 •C�i✓I
Fill in fee simple Title Holder on next page (if different
from the owner listed above)
Name: Y4—
Company: iosmtA �f 120V✓
Addres : /a'21 AvP� cS?1C•
City: V60'Ata&PN State: rl.
Zip Code: ' 2 4 U-o Fax: 1179 - of l'? -69 /
Phone No. _77%— Wrl- %iH irY
E-Mail: 1l F)v D �k/cDw( @v15 �ru�++� t • Cam
State or County License: C(a Ci /50�%�a
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCT ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: of Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
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 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 concurrenry 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordine vour Notice of Commencement.
Signature of Own,er/Lessee/Contractor as Agent for Owner
Signature 9� ractor/License Holder
`OFOMCI
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COUTNTYOFORInCAiah Ill
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The f oing inst ent w s acknowledge¢pefore me
this ff ay osM4YM J 20�11 by
The forgoing instr nt was acknowledged b ore me
this day of ` �� 20� el
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
7;;_>�
Type of Identification
Produced
oduced
l
(Signature of Notary
(Si nature of Nota Public- State of Florid
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a+ RENEE-E'EISWERTH— —
Commission No. _ • WCO(®U@fN_i1FFQWIQ—
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COMMISSIOM%GG016744
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'•F,al�q-•' BaMMTWWW PubVa Undemllen
July 31, 2020
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Rev.8/2/17