HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO 1-7
IMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
>- r� M41''LV FEB 13 201/
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
PERMIT APPLICATION FOR:
-15
- -
Address:
Legal Description:
Property Tax ID#: �'��� m C -06c15-606 " -b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Ad d itiona I wo rk to be pertorme u nd er th is permit-check a'1.1 that appy:
_Mechanical Gras Tank _Gas Piping —Shutters _Windows/Doors '.
Electric ,dumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ g Utilities: Sewer _Septic Building Height:
Name c;'.&.7 ,S` �r Name:
Address: ? 0 Company: �� o. j .►�So`
City: -cr-CP State: Address:
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Zip Code: 3ti'5 L44 Fax: City: mwj �aL, /1tree'-, ' Stater
Phone N17 7 0 F3 C1- (7 T J Zip Code: 7i'ih 41�] Fax:
E-Mail: Phone N,�j7 -L� kf o
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner'iisted above) State or County License zt9 b
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
50,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.
Tl e 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 Raying 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 obtai financing; consult with len r or an attorney befo
Commencing rk or recording our Notice ofElqftmencement.
Signature of Owner/Agent/Less ee/Contracto Signa re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI A ,
COUNTY OF S Luc ` COUNTY OF S -• t N)e��
The forgoing instrument was acknowledged,before me The forgoing instrume t was acknowledged before me
this\ 'J day of 20� by this �'� day of T 20AI by
C V� 3V-0 ti.� r 5 46 S a
(Name of person ackn wledging) (Name of person ac nowledging)
(Signature of Notary.Pu c-State of Florida ) (Signature of Notary Pu is-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi tion Type of Identification
"••• N
Produced L— IEGNENS Produced EANNAMARIEGIVFS tel. .;�w
ISSION#GG 0?^t023 MY COMMISSION it GG 022023
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Commission No. 1 pR g:D` `�bUeUndeTM16,2020 lere Commission No. EXPI6> Cember16,2021
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fi Bonded Thru Notary Publk Undernritar:jai
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE j
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED' !
- DATE
COMPLETED
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