HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:' `�
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Building Permit ApplicaPlannin and Develo mentServicesepartmentg PBuilding and Code Regulation Division nty, FL2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resenta
PERMIT APPLICATION FOR:
PROPOSED INP1-Ciro grim M-
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Address: SS II r Jv& 6tk ,��
Legal Description: LAA, 1,-YJV'/ V.
XJ Vl)n�� - ( \Y.`�e1 - LD'r
Property Tax ID#: 1�>O1- 66,A- QnS- 00p -1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DOWLIED N&GRIPTI®N
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C�'NSTRUCTIC� 1N`F®R�i�/IATf��N`: �°�
Additional work to,be pertormed under this permit-check all that apply:-
-Mechanical
pp y -
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator 1/Roof '7 Pitch
Total Sq: Ft of Construction: Sq. Ft. of First Flo.or:- _.
Cost of Construction:$ -J) giyb Utilities: —Sewer _Septic Building Height:
OtiNNiER/LE=�SSEaE• �4 CONI"RI�C�°O:R.
Name Ac rLe- i�\\ems Name: m �1� W,
Address: S51i )FA PWt,-, 121 Company: ne- 1 -
City:E&A R-erGe-- State: WL Addr s: (ICt73 Off .2
Zip Code:3`91 (&T( Fax: City:+&+raA 1ot,le,, State: r(
Phone No.-Tla-4� -IT3W Zip Code: 34197 Fax:
E-Mail: Phone No --)'?CL-9(� O - 56` '
Fill in fee simple Title Holder on next page( if different E-Mail &ve-AcAa. ® 'ezen
from the Owner listed above) State or County License e /-zo
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRtlCTI®N :LIEN L.�V1( IN;1=0RM� I'O:N:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
_..-- -. .Name: - ... .:. - Name: - � - - - . - • ..
Address: - Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER::.: _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
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commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contra to as Agent for Owner Signature of Contractor/License Hor
STATE OF FLORI STATE OF FLORI '
COUNTY OF ;ol' `` COUNTY OF
The f rgoing instr ;Rent was acknowledged e csr 'm The fQ�oing instr ent was ckn6�4
owledU6 -
2
this day of 20 � this0� day of 0
m
a 546 9c�Do0(Name of person acknowledging) 3 (Na a of person acknowledging
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JJ 9. N
(Signature of o ary ublic-State of Flo ida) (Signature of Nota ublic-State of Florida) ff
Personally Known OR Produced Identification / Personally OR Produced Identification S
Type of I tifi tion Type of Id ntificati
Produced Produced
Commission o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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