HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `Q �-�� Permit Number:
SCANNED
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St. Lucie County
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ✓ Residential
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JUN 0 4 2019
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PERMITTYPE:
�RQPOSEp tiIPROVI}MEI�T
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Address:-?J(Los 0ogorl JV,ve-
PropertyTaxlD#: 335'35' 14_l-0006-000 .tl; Lot No.
Site Plan Name: ege.eOLn IOWAF-r-S Block No.
Project Name: Daeaxl 1 bw e-v-ra
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
Total Sq. Ft of Construction:
Cost of Construction: $ qr c1 4 ()
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Pitch
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Name 0Ce- 1 1DWLy1 anCLC)S 6
Name:aiC*)in9J
Address: c ct-DO c; Q Ce0 / 1 Ti]'LJe
Company: M-u-D- 'f FeDC& 12001 O��
City: eVt B e_oxx% State: FL
Zip Code: 34 15 1 Fax:
PhoneNo.. ?At7- la'71- 310ga
Address: P X fo.3(o
City: 54:Li n + State: FC.
Zip Code: 345"cr.15� Fax: 77a-a88-3035
Phone No 77a-a��-/i��
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail 54un v+r- eYtCE (A6e.1161)w-kn. n e J"
State or County License r3.05 7
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW (4
17.,
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: , _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 JOB v,1EE BEFORE THE FIRST INSPECTION. IF YOU WTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR DER WAi ATTORNEY BEFORE RECORDING YOU ICE OMMENCEMENT."
Signatur of O er/ Lessee/Contra or as Agent for Owner
Sigrikilitll Contracto Lice a Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF IVI/W I—/!n
COUNTY OF Vt
The forgoing instrument was acknowledged before me
The for ng instrument was acknowledge before me
May
thisay of 20� by
this of 20 by
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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
Produced
(Signature of N k/'iIMa�4fYAef1
(Signature of Nota Il - tI Ir
FlorWe
.y+ Notary Public Stele d Florida
Commission No Diana K AIM f`P��,rot
Notary uDlk of
�� � Diane K BOrld_
Commission No. Commlaiyh�}'t8670t
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0M Expires 12=2022
REVIEWS FRONT
ZONING
SUPERVISOR
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MANGROVE
COUNTER
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DATE
COMPLETED
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