HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / �- �7. Permit Number: ( 7� �– 0
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Building Permit Application OCT 19 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
PERMIT APPLICATION FOR:
3,
PRaPtJSED INROUEMENT LOCATION
Address: CInori- ��fCe
Legal Description:
Property Tax ID#: 7����"' rJ �b� " �� b ' 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE1`AII.ED QESCRIPTIQN OF WORK
CONSTRUCTION INFORMATION v
e:
Additional work to be pertormed under this permit–check all tat appy:
7M chanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq:-Ft.of First Floor
Cost of Construction:$ �5�, Go Utilities: —Sewer —Septic Building Height:
O1IVNER/LESS,EE CONTRACTOR:
Name a Name:
Address: 32/6 S � S� d� Company:
City: 6r't Ce State: Address:
Zip Code: a Fax: City: State:
Phone No. (9Zip Code: Fax:
E-Mail: r Oi ' C gzi, Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'CONSTRUCTION LIEN. LAW fIVFORIVIATION
DESIGNER/ENGINEER: —No.t 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 Comm cement must be recorded and posted on the jobsite
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before the first inspection. If you intend to � ncing, consult with lender or an attorney before
commencingWork or recordin our Notice`' f COW' encement.
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Signature of Owner/Lessee/Contractor Agent fo 3 o I Signature of Contractor/License Holder
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STATE OF FLORID �X STATE OF FLORIDA
COUNTY OF zl' o COUNTY OF
``fit IbOi
The for oin instru pent was acknowledged efore rr{+ _;�`"
g g The forgoing instrument was acknowledged before me
this day of 20 l by this day of 20_ by
/,/2',LAO- ff
e of person king statemen . Name of person making statement.
p
/1,162 4-HGt» r C/ Fced�r� —
PersonallyKnown OR Prod Idents kation PersonallyKnown OR Produced Identification
Type of Identificatign ,�`g, Type of Identification
Produced ��Gtil/ J (`C.. Produced
(Signature—of Not r Public-State of Florida (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17