HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit N uImber:l
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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 .I R sidential
PERMIT APPLICATION FOR:
PROPOSED NO' bVEM€NT"LO:CATIt N `r v
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Address: J'20/ f� i`}
Legal Description:
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Property Tax ID#: 3'90 6o 15% w ~ —2 it i Lot No.
Site Plan Name: i Block No.
Project Name: I
Setbacks Front ac : Rig t I e iS`de:�r
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DETAILED DESCRIPTIQN.OF WORKs
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CONSTRUCTION IiV:FORIUTATIOEN �e � � :
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Additionalworkto a pe orme under this permit—check a tat appy. I I
_Mechanical _Gas Tank _Gas Piping _Shutters i _Windows/Doors
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_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floo':
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Cost of Construction: $ �Q Utilities: _Sewer _Septic Building Height:
.INNER%LESS,EE . �
CCiNTRACTQRti
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Name J- Name:
Address: Company:
City_: f , k State:, Address:
Zip Code: .2�9� Fax: City: i State:
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Phone No. 7V, Zip Code: J !' Fax:
'E-Mail: LT2&)21--1✓j1-Le w' 6?r -0-i I a Zonl 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.
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SUPPLE111EN4* PN,5TRVCTION.LIENIAW INFORMAT.ION
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.
Signatuffi of O 'er/Les!ree/Contractor as Agent for Owner Signature of Contractor/License Holder
1." 0/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Th forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-3._day of TYknOQ 1n , 20J2 by this day of 20_ by
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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
(Signature of Notary Pub ic- ate of Florida) (Signature of Notary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
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Nota-y Pl blic�Statte F orid
REVIEWS FRONT :MyC mSJPE 1/,I 2�t�?f
NS VEGETATION SEATURTLE MANGROVE
COUNTER mmS51VIIEW 177,q,R� EW REVIEW REVIEW REVIEW
OF FL
DATE ? rougn National Notar_ Assn.
RECEIVED '-
DATE
COMPLETED
Rev.8/2/17