HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1� U-�
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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: 2
Legal Description: W0 � 2 Al. �&CISA
Dmf hioze XY
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Property Tax ID#: �y3�" 0 0% 00,07 — 202".5 Lot No.
Site Plan Name: Block No.
Project Name: t
� 1re�/I OR ,L
Setbacks Front Back: Right Side: Left Side:
DETAILEDDESCRIPTION OF WORK:-",-'
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CONSTRUCTIONINFORMATION:
Additional work toe e orme under this permit—c ec a appy:
HVAC f]Gas Tank' E]Gas Piping _Shutters Windows/Doors
Electric O Plumbing OSprinklers 11 Generator ORoof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor: %� q
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWN ER/LESSEE°: CONTRACTOR: GC
Name Name:
Address: Company: �'� o
City: rrh�eK- StatOG Address: ldQ
Zip Code: C10 Fax: City:
Phone No. 772. 206 97&3 Zip Code: j2f,3 Fax: 7
E-Mail: Phone No. 7
Fill in fee simple Title Holder on next page(if different E-Mail: t SMAA A62g ,L�YL
from the Owner listed above) State or County License: ,(��3 3 Dov If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMEN , CONSTRUCTION LISEN LAW INFORMATIORI:
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 thepermit 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,
accessoy 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, nsult with lender or an attorney before
commencLing work or recording our Notice of Commenceme it.
Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORID / STATE OF FLORIRA
COUNTY-OF - �. C u cw a COUNTY OF %_%. o c%'k.
The fo going instru t wa ackn wiedged before me The forgoing instrument was acknowledged before me
this�ay of 2&_Oby this ;�G day of S $ 26 1 by
La, ( -r) vNc 644%<O.9
Name of person making statement Name of person making statement
Personally Known_V OR.Produced Identification Personally Known - OR Produced Identification
Type of Identification Type of Identif'Lqationn
Produced Produced
DEANNA MARIE GIVENS
(Signature of Notary Put 14" to o &4ISSION#GG050970 (Signature of Notary be teffo; FORW IssION#GG022023
+;. .1 . EXPIRE :December 16,2020
Commission No. � 05,•••'
EXPIRESovember29,2020 Commission NO. ��'• 6ondedT No PubllcUnderw6tera
G�GDS6 1b�� /
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17