HomeMy WebLinkAboutBuilding Permit Application 4
All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: / Permit Number: Q `'1 Q
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-- Building Permit Application FEB 2 1 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. LUCi County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION 17011:4.1,
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,PROPOSED INPROUEMENT,LOCTION
Address: 9-✓l� Q —�� r�jj
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION'OF.WORK kApz
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CONSTRUCTION-.INFORMATION: f.;
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iti na wor to eperformeda under ispermit-c ec t at�appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost uction:$� (� t Utilities: _Sewer _Septic Building Height:
OWNER/LEE _ CONT ACTOR:
Name (, Name: 0
Addrps: // Company: 1 2 �1�
City: �- State: c— Add re s• ¢
Zip Code: : 4 State:
Fax: Cit s, Y C
Phone No. ��2 —�S [ Zip Code: -
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different -
from the Owner listed above) State County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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�SUPC�'LEtVCENTA ACONSrtRI� ' CQN LCCNA1 // INFQRf1JJ[aT1Q1 Xs`
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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 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
commencin k or reco rding your Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDALA� STATE OF FLORID _
COUNTY OF COUNTY OFg� . LL)
The forgoing instrument was acknowledged before me The for oing instru was acknowledged before me
this�day of �,Q 20�by this; day of 20 by
(Name of person acknowledging) (Name of person acknowledgin )
e�--
(Signature of Notary Public-State of P16rida) / (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification J Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced . p>'
" N S. NIELSEN
SIN
Commission No. ""' ommission No.
C ssion 9 FF 115637 K S. NIEL156
```i"pY PW",�` #FF 11 5637
My Commission Expires .� � ommission fres
%9F. oe =. — Al* Commission_1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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