HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / `
Date: j 17 Permit Number: �/ O '-
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NKMOVBuilding Permit Application
OCA' 31 201
Planning and Development Services
Building and Code Regulation Division D
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial L,-" Residential
PERMIT APPLICATION FOR:
"05'E-- N' OV,EMENT LQ:CATIaN
.. 464 g.
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Address: � � A �Ce�(�� � !�S � � •� Z 0/
Legal Description:
Property Tax ID#: 7 (� 1 �- �y^� �' Lot No.
Site Plan Name: y Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,QF WQRK'.
4 ADO-VA
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CONSTRUCTIONINFORMATION
AdclitionalworFtobepertormeffun er t is permit–cnecK all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ �� V 0 00 Utilities: _Sewer _Septic Building Height: /
QWNERJLESSEEC0NT, ACTQR.
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Name d'I Name:
Address: w rlbw Company•
City: c i e_ State: Address: 71f (
Zip Code: _Fax: City: State--
Phone No. 7 a.. ID � Zip Code: 3 Fax:
E-Mail: Phone No –
Fill in fee simple Title Holder on next page(if different E-Mail ear Cdn'1
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIIPPLEMENTAL,CONSTRUCTiN L{' N LAW INI✓C�RIVIATION` rc
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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.
Signatur of Owner/Lessee/Contractor as Agent for bWe i Signature of Contractor/License Holder p' as.....^?A
STATE OF FLORIDA STATE OF FLORIDA _ += . ....
COUNTY OF COUNTY OF ?I "' '' �'
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The forgoing instrument was acknowledged before l W �� The for forgoing instrum t was acknowledged ed bef6i,M
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this day of 20 by �' _ . this .�g day of 20_7 by'
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(Name of person acknowledging) ZI
(Name of person acknowledging)
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(Signature of Votary Public-State of Floridfl U (Signature of,Nry Public-State of Florid )
Personally Known J OR Produced Identification Personally Known ✓OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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
Rev.