HomeMy WebLinkAboutBuilding Permit Application d
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PROJP
POSED IMPROVEMENT LOCATION
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Address:
Legal Description:
Property Tax ID#: `tU —c JU�' � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D.ETAFLED DEStCRIPTION
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CONSTRUCTION INFORMATION " a "
Additional work to be nertormed under this permit—c ec a' t a appy:
❑_HVAC Gas Tank Gas Piping _Shutters Windows/Doors
.Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ Utilities: _Sewer 0 Septic Building Height:
O1N>NER/LESSEE , w CONTRACTOR
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a e:,
Name UC.kV(__ Name:
Address: O Company: L
City: V1 Q State: Address.:--)010
Zip Code:3Fax(: City: l gq2s State:
Phone No. Zip Code: Z Fax:
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E-Mail: Phone No. �U
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ??L1U I LQ�(�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTION LIENLAIIV INFORMATION`f $L
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.
Signat ner/Lessee/Contractor as Agent for Owner Sign ure•of Contractor/Lic&se Holder
STATE OF FLORIDA _ STATE OFF4ORID V
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of W ,20� by this day of N6\( 20_n by
Warne of person making statement ame of person making statement
PersonIlly Known OR Produced Identification Personall Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Si na ure of Notary Public-SWate of Florida) [Sigi4tdre of Notary Public-Ate of Florida)
Commission No. (Seal) Commission No.; , _(Seal)
!_ASHAHNA(NGRAnl
�OSPRY rUe�i':
E .,. �• �,� i o Notary Public-State of Florida
PGa, LA•HAHNA INGRAM z'�; n°a �y anon. txpires c 20,201St€
REVIEWS FRON` s`3° IN"CytaryPASUPERVISCDEri la LANS VEG'Ert%k;' SEAr'T-'07012E#F 'N7RGROVE
°° 'EVIEW REVIEW" Bond irEWNation Not
COUN ' xi Mcorn FyREV1E-W20,2(1c — REVIEVI/
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DATE O
Bonded thrc ughPIS`anal�!oh r
RECEIVED
DATE
COMPLETED
Rev. 8/2/17