HomeMy WebLinkAboutBUILDING PERMIT APPLICATION6�'
All APPLICABLE INFO MUST BE COMPLE1 I U) FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
t. L RECEIVED
S ucie County
Building Permit Application AUG 2 8 2019
Planning and Development Services
Building and Code Regulation Division -ST. Lucie County, Penmitbr.G
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE: kz
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Address:-40qo 1�. M',a(,yaq pA.
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Property Tax ID #: q C)5 0 Co() 'Coc Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit -check all that apply:
—Mechanical GasTank — Gas Piping — Shutters —Windows/Doors
— Electric Plumbing —Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction: I - 0 Sq. Ft. of First Floor:
Cost of Construction: $ o b Utilities: —Sewer _Septic Building Height:
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Name jb�-R 0zlik4y
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Name: SnL)CQ-
Address:11h 2 M%ah oeml-Dr
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Company-_R+T73 I frLAQ
City: cocoa , , State:
Zip Code: 32q.9-& Fax:
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Aciclress:loq-�2 SE UlK
City: State, FL
Phone No.
Zip Code:,:'A q 2� 0 Fax:
E-Mail:—
Phone No-'31;;2 - 36(4--'�-COr'i
Fill in fee simple Title Holder on next page (if different
E-Mail tl-R) ro Ork. cbm
State or County License C
from the Owner listed above)
I
If value a 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.
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DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _NotApplicable
BONDING COMPANY: —NotApplicable
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anscovenants 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-residenfial use
RWARNING 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 BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
-5—gnature of owner/ LeshejecrrT- ner
I�re of CoAtract(;r—/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF MA9_)0N
COUNTY OF hA ArfI ON
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 2Zday of IMAMS+ 20 P? by
this _;&ay of FN!l Q S 4- 20 Iq by
0
RENN15 500ccy
6,epoc-Ey
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
Aw Q f)
Produced
M2s2=0tc_ 4
,(Signature o%JdWy Public' St
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April 29, 2023
I ... 10 Anril 90 qno�
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MANGROVE
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SUPERVISOR
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COMPLETED
Rev. 217119