HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: NLN-TIK ME,
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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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:_QA 0 X t 1-r E f,_U_0
Legal Description: N��>LC S (.IJ40 _'35C-JL_ ?4 .C.CL
Property Tax ID#: 1 1106 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
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CO'NSTRUCTIO'N INFORMATION:
: Additional work to e e orme under tispermit-checka appy:
_HVAC Gas Tank ❑Gas Piping _Shutters rlEJ Windows/Doors
Electric 0 Plumbing []Sprinklers ElGenerator 11 Roof Roof pitch
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Total Sq. Ft of Construction: SFt.of First Floor:
j Cost of Construction:$ 3 0C) Utilities: Sewer Septic Building Height:
;OWNER/LESSEE: CONTRACTOR �; k ,,! � ';
Name E J -s Name: !Zt C JJA M Q . Vbll-kA l?-f
Address: c_�-G Pl R.EFL'1 ( A Company: CO �k `- v All, tl-'(-
City: SA State:_ Address: G3 3 N/s Pau A) Z."J
Zip Code: �4b9 r) 3 Fax: City: ?-5 -4 State: L
Phone No. 96) /,IOU _-306 f Zip Code: 3 q 9'b,) _ Fax: /
E-Mail: Phone No. 1151A 2rl oQ "5-f
Fill in fee simple Title Holder on next page(if different E-Mail: fro t,]<A V=-
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from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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II I UCJIla1Vt1(/EIVl711VEtK: _NOT Hppncame I MORTGAGE COMPANY: Nnt Anplicahle 1 II
II I city: Siaie: j City: -State: III
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FEE SIMPLE TITLE HOLDER: _Not Applicable I RODDING COMPANY: _Not Applicable Iii
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City: City:
Zip: Phone: I 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
commgKing work or recording our Notice of Commencement.
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Signat re of O ner/Lessee/Contractor s Agent for Owner Signature of Con or/License Holder
STATE OF FLORIDASTATE OF J COUNTY OF FLORIDA ,
COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instr Went was acknowledged before me
this day of 20_Q by this al7day of 20D by
Name of person makink statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro ced 1— Produced
ra6lX1,�\SM, - rtan&,9
I tur of Notary Public-St of Florida) (Signature of Notary Public- to of Florida3 0a
)
Commission No. (Seal) Commission No. ,,,�,,, L '90
L��3R�4VA INGRAM
Notary Public-State of Florida
...._.,�»wv.- �pF- ?• * My Comm.Expires Dec 20,2018
Not r ' ublic-State of lorida �'%� F Q°;••'` p� i'
REVIEWS FRONT t'oug ���'i1�1�, rVE; ,'
COUNTER MY P&T `I Q92 .2(A NS VEGETATI
• � If- F 17 2aj�EV W REVIEW R IEWj REVIEW
DATE '. through National of ry ssn.
RECEIVED
DATE
COMPLETED
Rev.8/2/17