HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE NF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ( I
Permit Number:
Building Permit Application
Planning and Development Services 11
Building dn"W Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR
:
Address: $3�S ti V I V .��►
Legal Description:
Property Tax ID'#: �' l Lot No.
Site Plan Name. Block No.
I
Project Name:
Setbacks Front Back: Right Side: Left Side:
itiona wor to be performed ++under this permit-check all that appy:
Mechanical —Gas Tank Gas Piping .Shutters Windows/Doors
Electric Plum Ibing : T Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: I Sq. Ft.of First Floor:.
.Cost of Construction:'$ Utilities: Sewer _Septic Building Height:
4 W
1 Name Name:
Address: IMFIL fuS &dL bUlcompany:
IN. s ` Address:
City:,
Zip Code: Fax iI City: State:
Phone No. 11 Of)-)- It ' Zip Code: Fax:
E-Mail: (Itis (4 . c Phone No
Fill in fee simple Title Holder on'next page(if different E-Mail
from the Owner listed above) Ii. State or County License
if value of construction is 2500 or mare,a RECORDED Notice of Commencement is required.
i .
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
commencirIg work or recording our Notice of Commencement.
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Signature o,Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTN OF' COUNTY OF
The fo oing instr ment s a knowledg, d before me The forgoing instrument was acknowledged before me
this�day of 20a by this day of .20_ by
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(Na a of erson acknowledging) (Name of person acknowledging)
(Signature of Not ry Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known a ification Personally Known OR Produced Identification
TypeF Type of Identification
Prod��cecf�AaYIP�e!' .tlt�lic. a ot.Florida
o Produc „
'_• `� Commission ,., y'P
»�' Comm.Expires May 21.20-a
+Commis iG o�Pp *� � Notary Public-State af`Floridal.
Com 1, OQ;c MY nalt4otar)SL _ #FF 234r
o„�,�° Bonde -
' ° ` = My Comm.Expires May 27,,2019
NtatinnA NotaryAssn.t'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE ' .` MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW y ` REVIEW
DATE
RECEIVED
DATE
COMPLETED
ke—V.7/2014