HomeMy WebLinkAboutBuilding Permit Application i '
ALLAPP1.10f BLE lrJFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , c�� Permit Number:
• �'SJy l
RECEIVED
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Building Permit Application JAN 2 9 7018
Planning and Development Services
Building and Code Regulation Division Perml ing Department
2300 Virginia Avenue,Fort Pierce FL 34982unty
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential=
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PR'OPOSED;(MPROV'EMENT LOCATION. E # r
Address: j �G�y`il�(1Cl
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
tDETA1LED,DESCRIPTION OF WORK. '
C=oc y,6\
Pao 14n L(Lker1 o
,.. - -_
.CONSTRUCTION�INEORMATION `
tions wor 'to e ne orme under is permit–c ec a "apply:
HVAC U Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator g Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ L,Sga ci 0 Utilities:0 Sewer OSeptic Building Height:
01NNERAESSEE p'. _An CONTRACTOR _.
Name Yl r� i Name: t C,.� rte?
Address: 4 "\a 1 �� Company: n� cSC _ —
City: A—.0 - .Lt:) [ZC-QJ. State:�k_J Address:
Zip Code:a q Fax: City: Stater
Phone No. '�1 �A - LAD() — q y Zip Code: 3 � Fax:
E-Mail: Phone CI S�-4 x`51 'r7 11 O
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.
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Sl1PPLENiENTAL CONSTRU:CTtON+LIEN tAW'NNFORMATi0N
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.
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Signatur o er/Lessee/Contractor as AgenYfor Owner 5ignat r C ntractarJLicense Holder
STATE OF ORiDA STATE OF FLORjQA
COUNTY OF 'l' c COUNTY OF `tom M'C}wc�t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 5 r1 .201 by #his day of 'tea r^, 201 by
CA 0 2.k J A G GA �� C .V—\ o, dry G -
Name of personm— aking tatem t Name of person making stateme
Personally Known OC, ^OR Produced identification Personally Known�_OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of(�ot�r,Publi€.-State rsf FIST a (Signature of Notai y,8gbUc-Stag#' for
t FPA1,1�E5 ELl.0-N j-A, 14.1< .w �1},tCEs I LLE14 ZARIGS< `
CommlSSli!`•.. u`(.Y GomrnisSion 3r Si 9F�I' 1Qn�:, �ptutwinn i ��92 5185 (Seal)
�s m�-,melon rr��"+`t'' II .. J' eros
o. *? r,,fltnmissiorr Ex(�
I s,� ocibber 04, ?.019 3 �, �. 14t 4 ?_Q]S'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17