HomeMy WebLinkAboutBuilding Permit Application All-APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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_ Building Permit Application 'I
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:
Address: S A)hcN Lcvq-
Legal Description:
Property Tax ID#: I L130 —702_ Oot 3 - ®w - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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WPM MOMEW
01ScuNJ e vvid e l L,-,,Al , Qf-60K 0111itT Ct 2
i (-e Set.
Additional work to be perrormed under this permit-check all that 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 of Construction:$ QUO Utilities: _Sewer _Septic Building Height:
Name d Name: V
Address: 2t-7 l Company: I�JA`reti.,
City: D,yeAskory Stater Address: Y moi+► r.Ke�' .
Zip Code: LI a 3 u 3 Fax: City: , iyvr_ State:
Phone No., a-70 3iL 4166Zip Code: 3y�'�i'� Fax: —65S7fO
E-Mail: ,y 6'. vV1 CL(ri/ 1DO70 Juwj . wtr• Phone No. w- O
Fill in fee simple Title Holder on next page(if different E-Mail: UJ L(� o�• ��''
from the Owner listed above) State or County License: 13 o O SSS/-7
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of construction is 2500 or more,a RECORDED Notice.of Commencement is required.
11511111111
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 of Commencement.
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Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORID4 STATE OF FLORIDA
COUNTY OF COUNTY OF b �
The forgoing instrument was acknowledged before me The for ing instrument was acknowledged before me
this ') .day of 20J_J by this Tday of 20 nby
Ta �-C• ast�nt�o�
'(Name of person accnowledging) (Name of person acknowledging)
Sign re bf Notary Public-State Florida) (Signature of Notary Public-State o orida)
Personally Known OR Produced Identification Personally Known �,__0_R:9roduce04dentif_ication�,
Type of Identification Produced Type of Identification Pr d' uceil1 � LASHAHNA INGRAM
,i c s Notary Public-State of Florida
Commission No. # `'(Sal ''� No. * MY D�(S�agpires Dec 20,2018
LASHAHNA I
`A` s Notary Public- tate of Florida � � Commission FF 177249
"_ ������� Bonded through National Notary Assn
ee= i n #FF 177249
REVIEWS FRONT ZO4NJQ,o.,„% = tionaQl�� ssn.+')' VEGETATION SEA TURTLE MANGROVE
COUNTER REVIE ,VI . - -RE.VIEWz;;A- REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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