HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABrE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �-
Date: S I ��I I .! 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 Commercial Residential
PERMIT APPLICATION FOR:
Address: ,;2= l .5 N
Legal Description: W i Le V
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
- 00 57/ - 000 - I
_ Right Side: Left Side:
Lot No._
Block No.
_Mechanical _ Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
,Cost of Construction: $
_ Gas Piping _ Shutters_' Windows/Doors
_ Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First. Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/ Ll ES�SEE:
CONTRACTOR:
Name M(5YZ5_U4; I :T[01�12en) Oo/2
Name: a7_1b (',O�KTiZuC,TiDIJ . i,j_G
Address: 9,)5 J-4.
Company:�j n iii 17S 1 W t
City: � ) eru G State:�L
Address:
Zip Code: 34 4'] Fax:.
City: i7t State:_L
Phone No..
Zip Code:
E -Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E -Mail ON l r)(Q cook,
from the Owner listed above)
State or County Lic ns°
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTR'UCTIO'N LIEN LAW INFURI ATINBC:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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 thepermit 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
commencine work or recording vour Notice of Commencement.
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Sign re of 0 r/ Lessee/Co ra r as Agent for Owner
Sign a of Co r ctor/License Ho.
STATE OF FLORIDA J
G`�
STATE OF FLORIDA `
COUNTY OF L.
COUNTY OF
The forgoing instrurpent was acknow ledg c( before me
3�-2iay 20�!/by
The f r oing instr��}ent was acknowledg efore me
this, rA 20
this of
ay of [by
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( e of per on acknowledging)
(Name of person cknowledging )
FA rn L�
(Signature of Nota y Public- State of Florida)
(Signa of Notar tublic- State of Florida )
sonally Kno
no er ovally ic`n, OR Produced Identification
Type of IdentiDca ANGELA M HUFF
Produced ;�° a` Notary Public State of Florida
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Produced .`�°`P�YPOA�.% ANGELA M HUFF
• Commission F FF 234730
Commission N�o.9r p°:�- My Comm. Expire 12019
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
'REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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