HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Durl) . oaqcq-
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: To Select from dropbox, click arrow at the end of line r
PROPOSED IMPROVEMENT LOCATION:
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Address: W C,tf
Legal Description: C�1✓1 U t\ 1 �2� �/1 ,1P AAic:
Property Tax lD#: }"I - l " 7(0 00( - q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toorme un r this permit-check a appy:
HVAC RGas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric F-1 Plumbing FISprinklers U Generator 61 Roof Roof patch
Total Sq.Ft of Construction: ) Q a D Sq. Ft.of First Floor:
Cost of Construction:$ ( 6 Utilities: Sewer 11 Septic Building Height:
OWNERAESSEE: CONTRACTOR: F
Name ri Name:
Address: Q 11 .W aw Company: r'tt
city: L,il kz- {State: PL Address: Pi 16 S w ; n S
Zip Co e: !>49 S 3 Fax: city: --b or 1 5 t, zdc It State:feL
Phone No. Zip Code: 3V 9JCq Fax: 77-5-3q,3- 935Y
E-Mail: Phone No. "3'7
Fill In fee simple Title Holder on next page(if different E-Mail: C. 'I,
from the Owner listed above) State or County License: 3
N value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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 harder 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.
7_�_A 7�� 73--1 ];�_ S
Signa re of75wne0ttractor as Agent for Owner Signature of Contra o/ N er
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF LSt Luck COUNTY OF S L`^ _.
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The fo oing instrum t was acknowledged before me The for oing instrument was acknowledged before me
this day of V1 20 by this day of 1 V 1 fV( •20 loll
RcAr--6"') , R -_ J
(Name of persIM
ging) (Name:7
f perso knowledging)
(Signature of'fublic-State of Florida) (Signa e f N tary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Ide;�1n0
Type of Identification Produced a1h"tSb#94 Type of identification Produced
Commission No. �2. Self% ;��^�•,�'�' Commission No.
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COUNTER REVIEW EVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS