HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MIG-9f BE COMPLU ED FOR APPLICATION TO BE ACCEPTED a
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Dater (o�T SCANNED Permit Number:
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BY
�fft'e ='1 St. Lucie County
0
RECEIVED
Building Permit Application FEB 2 6 2010
Planning and Development Services
Building and Code Regulation Division
Permitting Department
St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: In I� UPS Gcntd. J�kk55 �(66f5
0,ROPOSED I WRROVEMENT
L0CAT )ON
Address: g050 5. OIcCInA - l id &4r FL
3y957
Property Tax ID #i: 147159-- 503 -(JWP3 -60Q-4o
Lot No.
Site Plan Name:
Block No.
Project Name:
Inlu�r�dl�l s a.r4t� lftc f nc, otf� Ss%% ac�alrs
CONSTRUCTION°INFORMATION
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Additional work to be performed under this permit - check all
that apply:
_Mechanical ,I _ Gas Tank '
" _ Gas Piping
_ Shutters,
„' Windows/Doors '
_ Electric _ Plumbing
ISprinklers
_ Generator
_ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1 sl ocio
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
01NNERLESSEE
I ,`
'CONTEj/iCTOR
Name (tilt~, i
Name:
IliGt .
Address: 9`906'S'•,&L.eA,n JD !- %PD7( I
Company: . s
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City: , �RC( \ State: rL '
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dress- _ f✓ ' 16L
Zip Coder�Jli 7l6 " i "Fax:
City �ft�tlrt� t ` State:�L
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zip code: Jir'19�q` Fax:%1,Z"3 N'ib�
Phone N``o-- 7�7oZ'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail. Yt�lKA (e 0t1+UrZJ--GotA t /lc-4
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. `
S,UP ALE ENTgL`CONSTftl1 T
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 indlcateo.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count yy 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 mayrestrict or_prdhibit 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 aIgree�that I will,' in all respects, performtthe 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, BEFORETHE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
..w.t" vni 1" 1 cunton'rin wlil''ArTnnnivv [xFFnDP RFrribirinuc'rOUR NOTICE+OF COMMENCEMENT." = " • I • ' l
+
Sign ture of ner/ Lessee/Contractor as Agent for Owner
Signatu a of Con actor/License Holder
STATE OF FLORIDA,I
STATE OF FLORIDA�y
L UU
COUNTY OF UU °
COUNTY OF 31,
The for oing instr ent was acknowledged before me
this �day of aAq 20_a by
The for oing mstru ent was acknowledged before me
this �day of ruoA 20�ff by
YA/IIP 1' 1'W�i L;u
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known _ OR Produced Identification
Type Identification
Type of Identificatio
of
Produced
Produced
1P_
(Signature of N taryPub -' .at&QLFIc0M4PyblitStateofFlorida
+ I Donne Jmayrre Hall
rSigna5ture of No ry ublic-St ,,n,b. NoaryPuhhcState ofFlorida
. d ` onn
scion GG 2a7585
Commission No. 1512022
•
D75$ missionHall
GG5
a m scion GG 207555
sion No. t r
«w� e:Plresoansrzoz2
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
,REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.2/7/19