HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC`A�BL IN/FSO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: of -1" Permit Number:
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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 o mercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPR01/EMENT LQCA ION .3 s ,uK w
Address:
Legal Description:
Property Tax ID#: ' Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION
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0031VSTRUCTION INFORMATION `
Additional work to flGasTank
orme un er t is permit-c ec a appy:
HVAC []Gas Piping _Shutters E]Windows/Doors ,
0 Electric 0 Plumbing Sprinklers ElGenerator 0 Roof Roof pitch
Total Sq.Ft of Construction: ,,tt�� S Ft.of First Floor:
Cost of Construction:$ (0 V0• (�y Utilities:cn Sewer F]Septic Building Height:
OW ER/LESSEE
Name Name:
Address:1 o Company:
City: d State 1(41 Address: r
Zip Code Fax: City: StatF1 1q,
Phone No- - . Zip Code:54-99 Fax: •fU -J
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: DO 0,69L, z)(YL-
from the Owner listed above) State or County License: 6g .7��
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA'LCONSTRUCTION�LIEN LAW INFORMATION:
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:
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 of Commencement.
_ s
Signatur f Owner/Lessee/Cont or as Agent for Owner tg atur of Contractor/ ' ense Holder
STATE OF FLOR ° STATE OF FLORID
COUNTY OF� ft COUNTY OF,� &XI-1-
The f r ing instr e t was acknowledged fore me The for oing in m nt was acknowledged before me
this day of � s 20 by this day o / 20 4 by
6! r� `
(Na of p rson acknowle ging) (Name of a son acknowledging)
V 607��L 0,
(Signature of Nota blic- a of Florida 'gnature of Notary Pu c- tate of Florida)
Personally Known OR Produced Identification Personally Known R Produced Identification
Type of Identification Type of Identification Produced
LIBERTYAKING
MY COM N EE 877248 `Pik,, TY A KING
Commission No. Commission No.
EXPIR5:MSy 4,2017 ;r: :r_ AIY [ON EE 877248
'''• 4b Bonged Thru Notary Public Underwriters EXi'IRES:May 4,2017
--,--'-d otary Public Undorwriters
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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INITIALS