HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services JAN - 5 2018
Building and Code Regulation Division permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St.Lucie County
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: 1 � I n
Legal Description:
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Property Tax ID#: _ r `o .3 2 QQQ 1 OQQ I Lot No.
Site Plan Name: - Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona war to a pe Orme • un er t is permit-c ecK a ;t at appy:
Mechanical _Gas Tank Gas Piping r Shutters r Windows/Doors
ElectricPlu - n / Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:. .
Cost of Construction:$ �• �d Utilities: _Sewer —Septic Building Height:
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Name '
YG. Name:
Address: ( Yl. « Yd Company:
city:"rn)l State:EL Address:
Zip Code: .,S4 Q,q -4- Fax: City: State:
Phone No. 2 q 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
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
A ORti V,til
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:-
Address:
ame: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 proRm Notice of Commencement must be recorded and posted on the jobsite
before the first inspecti . If you ntend to olat�n financing, consult with lender or an attorney before
commencin work or r in our Noti of mencement.
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Signature of O /L ee/Contracto as Agen" �ia�r'W Signature of Contractor/License Holder
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STATE OF FLORI v m Cn STATE OF FLORIDA
COUNTY OF CM 2 COUNTY OF
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The for g instr t was acknowledge befo mew m The forgoing instrument was acknowledged before me
this day of 20L�by t:�o;� 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 IdQnti�i ation _ Type of Identification
Produced Produced
(Signature of N a y Public-State of Florida) (Signature of Notary Public-State of Florida)
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
ev.