HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��' 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
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '�Si CJ
Legal Description: 40 c 'IQ 0�-5
4'a I
���� I(]S (.Q•C1ct GG7 CW-%7,P 3�+IoSS)Cof
C1 LA 148a�
PropertyTax lD #: 1>40 3 . S2@ - Q\CY-1 • a te - is
Lot No. Ins
Site Plan Name:
Block No.
Project Name: oc'-o 2X v-�
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:Add
itio a workto e e orme under this permit- c ec all
Uappy:
l: tIVAC Gas Tank E]Gas Piping _Shutters E]
Windows/Doors
Electric 0 Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ U .� 9 . 6L' Utilities:nSewer D Septic Building
Height:
OWNER/LESSEE:
CONTRACTOR:
\
Name �GY162� �"\ 6 `�Q.�
Name:_
Address:: q U(\i'� �c�
Company:
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City: 'rCC'. Vke_CCQ_ State:QL--
Address:
T4-tW,
Zip Code: 3t i ijK) Fax:
City: T_')cN r ,z
Stater
Phone No. 5\ Lo -
Zip Code:
Fax: Q 51-F • 31$ - 22M
E-Mail:
Phone No. 1 1kS\4 - Sal
• -7110
Fill in fee simple Title Holder on next page (if different
E-Mail: s2! m-
c, o rt-.
State or County License: _CAc-
-(--F'Cz-1LAQ_
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
_
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conxict 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 rk r recording our Notice of Commencement.
t of Owner/ Lessee/Contractor a ent r Owner
a f Co ractor/License Holder
STATE OF FLOWA
STATE OF FLORIDA
COUNTY OF ' 161
COUNTY OF '���
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this'd S day of o.Q c>yc>y�`- .20_j-)by
this�i� day , 20SI by
'MCrana4� �G"o60�Q-
oof.Csx-.(''
���`G.IL�. 'CC7�SC1J6�-'
Name of person making statemiInt
Personally Known OR Produced Identification _
Name of pen n making siratement
Personally Known OR Produced Identification
Type of Identification - ,.w.. _
Produced '."""fit STACIE PAG
f Identification
FHRodu ed P`°� STAC Ii= PAGURA
ri �r MY COMMISSION #F
88356 _ 'S€ MY COMMISSION #FF088356
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EXPIRES February
, 201 i a N�' EXPIRES February 2, 2018
Floridallotan6arvice com
J�aaa-SrtrvIce.
`of
^m SCA- ,:i
(Signature of Notary Public- 3tate Florida
(Signature of Notary Pub' -State of Florida )
Commission No.-R'U 4 K 3S(, (Seal)
Commission No.4�d F, r6 3516 (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17