HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater Permit Number:
RECEEIVED
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Building Permit Application NOV 13 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:
D4 VEM N T LOCATION
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Address: 01,plS LJ: L J Q C 2
Legal Description:
Property Tax ID#: -3�D� ' �' I — 006 Lot No.
-Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION aF WORK . O to
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CON5TRlJCTI6N INFORNfATION
Additional work to be pe orme under this permit—check all that app.,y:
_Mechanical _Gas Tank —Gas Piping _ShuttersWindows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Ur C Utilities: —Sewer —Septic Building Height:
01t1INERjLESSEE CONTRACTOR
Name lLl Name:
Address: 61..J Company:
City: 4�,51_— State:_ Address:
Zip Code: 2 Fax: City: State:
Phone No. /Sr��9 � ' I�l Z Zip Code: Fax:
-Mai : Phone No
Fill in fee simp a Title Holder on next page(if different E-Mail
rom the Owner listed above) State or unty License
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If value of construction is 2500 or more,a RECORDED Notice of Com ncement is required.
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SUPPI.EMENTAI CQ°NSTR'UCTION LIEN LAW INFORMATION
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 in ectwor
you intend to obtain financing, consult with lender or an attorney before
commencin wo or rin ourN pmmencement.
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Signature w r/Lessee/Contractor as Ag if it er Signature of Contractor/License Holder
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STATE OF FLORIDA 6 Nw 7 STATE OF FLORIDA
COUNTY OF — COUNTY OF
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The fprgoing instrument was cknowledge¢b� re„mem The forgoing instrument was acknowledged before me
this day of 20 ;a ”'"°'�o this day of 20_ by
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(Name of person acknowl dging) (Name of person acknowledging)
(Signature of Nota Pu ic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of I n 'cation /� Type of Identification
Produced . .t"C Produced
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
Rev.