HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I FO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: ! _
w.Y
Building Permit Applic tion
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_
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.77 - T
PERMIT APPLICATION FOR: -. -. - -. - i' i ,_ - "-
PR i OSED INPROUEMENT LOCATION:
Address: 18 ILI U SQD7- L )Y 11�1'CE FL
Legal Description:
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Property Tax ID #: o? Qjv? / — 3 �}oi —aoa4 -- 0001$
Lot No.
Site Plan Name:
Block No.
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Project Name: nCe-
Setbacks Front Back: Right Side: Left Side:
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DETAILED DEQ-SCR PTION OF WORK:
Qecn
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CONSTRUCTION INFORMATt®N:
Additional work to be performed under this permit — check a that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator
_ Roof Pitch
Total Sq. Ft of Constructio . Sq. Ft. of First Floor: u
Cost of Construction: Utilities: _ Sewer _ Septic I
Building'Height:
OWNER/ E-�SSEE: 'C®i�TRACTiR:
-
Name auAe ,-� CL'� e
Name:
n
Address: /�ILk t"e5�1f 6�d�- Ur
Company: I; I
City: io 'e&V_ State:L
Address:
Zip Code: Fax:
City: .' State:
Phone No. -02 M - 7-85-0
Zip Code: Fax:
E-Mail: f�)-U@ //9)l00 'd; OA
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or unty License
If value of construction is 2500 or more, a RECORDED Notice of Comm cement is required.
S,UPPLEMENTAL CONSTR�l1CTl®'N LIEN LAW I°N�F®R`MATION`:
__
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:
Address:
Name:
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 whi&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'aceessory 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
-01MMenCing WUFK Ur FUCUIU1119
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Signature of Ownerj Lessee'/Cont`racto`r as Ao t fob Owner _ ' —Signature of Coritracior/License Holder --
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�L UC�-Q- COUNTY OF
The f rgoing instrum nt was kn wledged�before me
this day of A 0 g 20 1
(Name of person acknowledging )
(Signature of Notary P blit- State of Florida )
Personally Known OR Produced Identification _
Type of identifl i n
Produced- ..
ANGEL OFF
'J. 1PUBSi
CommissioEl�t� Notary Public - Stater FI Ida
ti e` omm ion # FF 91--I
My Comm. Expires May 27.2019'
REVI
DATE
RECEIVED
DATE
COMPLETED
AW
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging )
ignature of Notary Public- State of Florida )
Personally Known _ OR Produced Identification
Type -of Identification
Produced
Commission No. (Seal)
COUN E�R ROEVI W I SUPERVISREVIEWOR REVIEW W PLANS � VEGETATIOEV EW ' I SEATURTREV EWLE M EVIEWVE