HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: \d 1 �3IO
SCANNED
BY RECEIVED
�f Lucie County
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APR 11 2019
-- --- Building Permit Applicat on
Planning and Development Services 5T: t"t' cultr �o m amg
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PPOSED IMPROVEMENT LOCATIONS
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Address: )V /4 (/4y /,Q %( .JD`f
Property Tax ID #: /�t l `r i2 o D 3 /7( 000 8 Lot No.
Block No.
Site Plan Name: mci��pp
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Project Name: J f'// lyn WeA—Alf7_/el 0
DETAILED DESCRIPTION OF WORK:
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CO STRUCTION 11NFORMATIONS
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 Constructions::c7J0 j F Sq. Ft. of First Floor: /a 30 ✓`F
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Cost of Construction: $ 6q d • �D Utilities: _Sewer _ Septic Building Height: J� r�
OWNER/LESSEE:
CONTRACTOR:
Name t7 oL
Name:
Address-/4 l nvf' 0
Company:
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City:�{U c�1li(soIV 15U?, State: FL—
Address:
City: State:_
Zip Code:.5044 Fax:
Phone No. o7D.3" 3 `76— g0 7/
Zip Code: Fax:
E-Mail: (/_� R.t 4(630)VT0/(1,,e/1r67, nfP_T�
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. �-
SUPPLEMENTrAL CONST ION LIEN LAW INFORMATII
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not 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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencJng work or recordinE vour Notof Commencement.
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Signs ure of Owner/ Lessee/Contr or as Agent for ,_ann
Signature of contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF Sai- ��
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this \\ day of '*k A� 20_ by
this _ day of 20_ by
Co'to\ o . Q%<yg
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced d.
Produced
(Signature of Notary Pub State of il
(Signature of Notary Public- State of Florida )
U�EANNAMARIE GIVENS I5b
Commission No.GCs - yco(849}011 02260 -
t6, 2026
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Commission No. (Seal)
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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