HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED
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Date: Permit Number: •
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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 Res.ide.niial
PERMIT APPLICATION FOR:
P s � t. pRo . oA-rloi. y
Address:
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Legal Description:��
Property Tax ID#: "4'50 , OCOC4•QQ03 i Lot No.
Site Plan Name: V! Block No.
Project Name: !
Setbacks Front Back: Right Side: Left Side: I
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Additional work to ge pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters i' _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floo�:
Cost of Construction:$ d b6 a v Utilities: _Sewer _Septic Building.Height:
'NAWN- w"i IN
Name Name: ! !
Address: /3,V-7 6A4401;- d-2� e-A � z/ Company: is
City: State: Address: '`
;Z' Code: � f��f` 7 Fax: City: State:
Phone No. 7?� X02 /� 48� Zip Code: Fax:
E-Mail: Phone.No !
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
Eyalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.CTIQN :N LAW�.' } NT4PCCN'S
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.
'Signature of Owner/Lessee/Contractor'as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF - � COUNTY OF
The for oing instrKnent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20/-7 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
'gna ure of Notary Public-Stato of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
LASHAI-1111A INGRAM
.�.., ai.."—onhlic-Stato of Florida
MY Comm.Expi'es Dec 20,20113
REVIEWS FRONT -,.. :ZONI_N,Gission ;SUPERVGSOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER "REVIEW_), -,'ilIionR_EV_I'£_Wi°_r? REVIEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
ev. 8/2/17