HomeMy WebLinkAboutBuilding Permit Application � a
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED E'
Date:
Permit Number:WN—
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F134982
Phone: (772).462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: VC �`&A ' }, 0�.
egal Descriptio n t tVA4 'f LIST,' ?1D t N'i
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Property Tax ID#: 060.Aonnn Lot No.�d 31
Site Plan Name:_(5 4() wexm Block N 4
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Project Name: ,
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Setbacks Front. Back: Right Side: Left Side:
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VC c--t 0 e
domonal worK to be performed under this permit—c ec :all that appy: I
_Mechanical Gas Tank Gas Piping _Shutters Windows/Doors
_Electric _Plumbing ^Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ Utilities: —Sewer Septic Building Height:
Name Name: , 1 ,
Addr V Company: c ` l�C.
City: _State:4 Address: i IIi KS au
Zip Code: Fax: _
City: r�1P/te..r?.., � State:,
Phone No. ^ � ( � Zip Code: J C 2., Fax: ;- _
E-Mail—' Phone No_-113\- '{� 6 �i'!l�i1p'
Fill in fee simple Title Holder on next page(if different E-Mail A 1,C4
from the Owner listed above) State or County Li icense S
If value of construction Is 2500 or more,a RECORDED Notice of Commencement is required..i
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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 norepresentation 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-record' our Notice of Commencement.
"XI
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License H er
STATE OF FLORI STATE OF FLORID •� 1 �
COUNTY OF '-AA(1( ��l e COUNTY OF (ri 1.-
The f r oing Inst ent was acknowledg d efore me The f going inst ment was acknowledg efore me
this mday of , 20by this day of 20by
(Name of person acknowledging)(I (Name of person acknowledging
( ignature of Notary Public-Stat6of Florida) ( ' nature of Notary Public-Statelbf Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatt1 Type of Identification
Produced 1._ Produced �� '
Commission No. (Seal) Commission No. (Seal)
{ t a , f% n nie infra nn ,•o<�+`Pio+, LASHAHNA INGRAM
`a Ff df5ry 06blic•=State f Florida �R.�Y µ, Public State bi Florida
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DATE ;
RECEIVED
DATE
COMPLETED
ev. 112014