HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED vim/
Date: Permit Number: ( l
,v � n, RECEIVED
Building Permit Application FEB 8. 2017
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
PERMIT APPLICATION FOR: .
PROPOSED IN�PROVEMENT LOCATION:
Address:
Legal Description: /� 1 v�'� ��1�/G �/.t�/T q F3 30 L o? /a
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Property Tax ID#: C/! 43— •��� 42161— 00 IP -- 9 Lot No.
Site Plan Name: , Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAILED MGRIP O OF&I=-
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C�ONSTR�UCTION INFORMATION:
itiona worK tope'.Peo;rme un er.t is permit—c,,ec a t_ at appy:
_Mechanical _Gas Tank _Gas Piping --Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator 11"�Roof F°! zPitch
TotafSq. Ftof Construction: Sq. Ft.of.First Floor:
Cost of Construction: $ S-SV 0 Utilities: —Sewer _Septic Building Height:
0%NER/LER& CONTRA TOR:
Name 4asG1} Name: GIG 3 ' �
Address: 27 `?a S G N4 P�?ON ;�7 Company: Gp_&_'pVx Z` Zvi L7L�L S, '� L L
City: �p 'Si �G vc/� State: FL Address:
Zip Code: Fax: City:/D<u 5 i- 2 e— State:_E_C-
Phone No. S -2-4 B -�_3 �3 Zip Code: �2N,9'g3 Fax:
E-Mail: Phone No 7`7Z '2-a4 9 11 (�
Fill in fee simple Title Holder on next page (if different E-Mail T3v%L707--5 i S Gd C14-ILW, (C'41
from the Owner listed above) State or County License LC L 1 E3 73
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVV INf®RMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
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 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
commencing work or recording our Notice c ncement.
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Signature of Owner/Lessee/Contractor as Agent for Wne� Signature of Contrac or/License HoldSTATE OF FLORIDA b z ��X STATE OF FLORIDACOUNTY OF o MQ COUNTY OFThe Wing instru nt was acknowledged before e� �T� The fo .oing instru ent was acknowledged bethis day of 20/� by g this day of 20 b
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nl - l ,i2T0 Y� nt 0
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of N P
ry Public-State of Florida (Signature of Notar ubiic-State of Florida) /
Personally-Known OR Produced Identification Personally n OR Produced Identification
Type of Identi i io Type of Iden ific io
Produced Produced
Commissiono. (Seal) Commission N (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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