HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: HJT`�1 Permit Number: �1O3�dto 1�
RECEIVED PEAR 2 9'7017
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:
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Address: 3�1(0 XVV 3
Legal Description:
Property Tax I D#: .I q C1 1 — 1501 — ®O LJ� — 000 Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AdditioAal work to be performed under this permit–check all that appy:
_Mechanical -Gas Tank _Gas Piping _Shutters _Windaws/Doors
Electric _Plumbing ' _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: ,,.,._.<,,.; Sq. Ft.of First Floor:
Cost of Construction:$ of)6 0o Utilities: —Sewer _Septic Building Height:
Name T-V_t►lA,Y*AC Name: L.�i G ' 4U.1^h �v,
Address: Co an � Z
lt' p .. Y
City: i ` State: ( ,Address: (D' o
Zip Code: 3 �? y 4 Fax: City: �51, P;-Uw! Stater
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Phone No. Zip Code: sy� –7 Fax: L146 -d_ab
E-Mail: Phone No. Y66 D
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: r ��
Et
of construction is 2500 or more,a RECORDED Notice.of Commencement is required.
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 i:o do the work and installation as indicated.
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.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF - ��. LtaC COUNTY OF
The for oing instrument was acknowledgl before me The forgoing instrument was acknowledged before me
this. day of W%. 20_ by this26N day of 'C 2031-by
LNN oo� ,tN�,e�J
(Name of person acknowledging) (Name of person acknowledging),
(Signature of Notary Pu c-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification .Personally Known .� entification
Type of Identification Produced L_ - Type'of Identifica ed D
_ MY COMMISSION#GG 022023
y DEANNAMARIEGIVENS
Commission No. � >�QB��fpMISSION#GGU22D23 ',Commission No. a. PIRES;I)e4rdQa11�202.0
cr - IXPIRES:Decetncet 1u,2020 •�... Thru Notary Pul,Ilc
BondedThruNotaryPublicUnderv�rita�s ! Undervmtar
OF i�•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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