HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: X n1AA �--f�� Permit Number. 1 � 0 (30,-3,�
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
RECEIVED
MAR 0 8 1018
Building Permit Application Permitting Department
St. Lucie County
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Commercial Residential
I PROPOSED INPROVEMENT LOCATION:
Address: <-/ �- I M j2Wl a� L��! P(2f? It-
Legal Description:
Property Tax ID #: 342:6-717 " (72-77 -000 "i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit - check all that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator 'ioof Pitch
Total Sq. Ft of Construction: %Com{ o Sq. Ft. of First Floor: / G�
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: (C
OWNER/LESSEE:
CONTRACTOR:
Name
Name: ZA
�i
Address: a )a-% f4 GW &,6jL6
Company:
Address: k,:�QZ2
City: e� State:
Zip Code: Fax:
Phone No > oL
E -Mail kaer -e
State or County License Cfl, /_?2-S2kj`
City: �1 State:jL1
Zip Code: 3 y �Fax:
Phone No. 77� "',-yU"��'
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 leader or an attorney before
commencing vVorIZZ;
_k�Pdecorcling your Notice of Commencement.
Signature r/ L ee/Contractor as Agent for Owner Signature r/License Holder
STATE O FLORIDA STATE OF FLORIDA
COLIN F `� L.yc+ r COUNTY OF Si LOC,a
The forg ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _3_ day of M M_Gin 20-1.6 by this ; day of iY1 i.ILC. k 201 by
(Name of person Acknowledging) (Name of person ayknowledging )
Signature of Notary Public to of Florida) (Signature of Notary Public- Stat Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L Produced L
Commission No. �,MyP'%,(Sea♦:grHER BURFO7RDfission No. FATHER BURF
¢r : State,;p�°�Y'�e°�
of Florida-Notar
_. _ t : State of FI
Commission _. _ ori a-Notar
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ommission Ex
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REVIEWS FRONT R2NS VEGETATION S N�nCDYO 2
COUNTER REVIEW REV EW REVIEW REVIE RLV1
DATE
RECEIVED
DATE
COMPLETED
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