HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7`f Permit Number:
.� 1; RECEIVED
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OR
FEB 272018
Building Permit Applica ion
ST. Lucie County, Permitting
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: CC�K-I CPL—
Address: 0
Legal Description:
Property Tax ID#: 3 () 9 - I - o C U _ s Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
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Electric _ Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: / Sq. Ft. of First Floor:
Cost of Construction: eo 00 Utilities: —Sewer —Septic Building Height:
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Name ,N hU a 9Q Sr Name: CRS C Le�oaf'/►•&"
Address: 4967AAe-Cck 14V'e Company: 1N ��� e(IU�-Z iA 4
City: -pa/`'�- �"-(Xe State: ',-L- Address: 5-0 Z! r 6A La n e� &,_ AVB
Zip Code: 3 y S Fax: City: P+ I?I'V'CC. State:
Phone No. Zip Code: Li 4 1/1 Fax:
E-Mail: Phone No. 7 7 2 - _TT6_6-- O S 4 U
Fill in fee simple Title Holder on next page ( if different E-Mail: \,t � reit\I.•-7_ / c: CSM
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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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 w rk or recooing your Notice of Commencement.
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Signature of Owner/Agent/L ssee Signature of Contractor/L cense Holder
STATE OF FLORIDA STATE OF FLORIDA o ... : •..
COUNTY OF Jc,;r•j LU c "e- COUNTY OF Sa; LL,c e-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before m ;
this day of k lagw,,y ,201 by this 7 day of fc4,� �a„� 20_AT by T M _
o o m O M
Le+o,r nea n trri'c_ L r z W
(Name of person acknowledging) (Name of person acknowledging) d Q cn
z Iu z°
(Signature of NotaryPublic-State of Florida) (Signature of Notary Pu ic-State of Florida ) o m
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. FFo9 C4c) (Seal) Commission No. FF091�gb3 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.