HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( 7 (��
Date: f D• 1 )� Permit Number:
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Building Permit Application OCT 17 2017
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 13CO(FOD�.
PERMIT APPLICATION FOR: CTL
PRdPOSED INPROUEMENT LOCATIC}N x
Address:
Legal Description:
Property Tax ID#:l ���" OC Lot Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAtI_ED DESCRIPTION-Of WORK
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6
CONST-, RUCTION INFORMATION "
Additionalworkto a performed. under this permit—check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
XElectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of.Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer , _Septic Building Height:
O-UUNERjESSCT
EE CONTRAOR .
m
Name Name: G'
Addres : !� Gv►./ / (�l'e Companyct(/ e
City: a l—f cyl L a S ate:_E( Address: C+
Zip Code: Fax: City: I_a<gl/2:6e49� Stater
Phone No. 0 . cQ V Le G Zip Code:22�O 7,7,_2 Fax:
E-Mail: Phone No&6
Fill in fee simple Title Holder on next page(if different E-Mail 42-apL
from the Owner listed above) State or County Licensef ;- �?aa 6 7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTALiCQNSI"RUCTI4N l:fEN LAW'IIVFORNIA7ION
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 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 recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder N
STATE OF FLORIDA STATE OF FLORI.- T = I
COUNTY OF j tz 91 COUNTY OF
The for oing instru ent was acknowledged beW;e >� The forgoing instrument was acknowled e�befo�e rr*;� z
this day of 20 ,� b' a this day of 20� by o�
m cNn iri ¢>w
(Name of person acknowledging) (Name of person acknowledging)
�Y ..54�`• 4 !
(Sign ure of Notar ublic-State of Florida) (Signature of Notary Poll c-State of Florida)
Personally K��o�wn OR Produced Identification J Personally Kno n OR Produced Identification
Type of Idehtific� i Type of Ide tifica
Produced Produced
I
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS. ,VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW_ REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014