HomeMy WebLinkAboutBuilding Permit Application AM APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED -
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Date: Permit Number:
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 1.)' Residential
PERMIT APPLICATION FOR:
Address: 7' a V-e_ U 1`G 4,j D -0-
Legal
-LIgal Description:
I
P`operty Tax ID#: (o "CJV - mon Lot No.
Site Plan Name: Block No.
Project Name.
Setbacks Front Back: Right Side: Left Side:
itiona Tor to a pe ormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:. Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Name �1l i s`H- Me T r I t I Name:
Address: 8.3s old�� � aC Company:A 41WmS lee �c� 02 LLC
City: f
e� `6eea C_ 4' State: 6�_ Address: 1,20 6 � { s4
Zip Code:'302 d 0 Fax: 9/9;L Gl9 -2031 City: V cr6 b r,-,4 State: �
Phone No.7) -999 03 V' Zip Code: 3a`l Z Fax: 99,-,995
E-Mail:Q. c������f10E 'Va�c?e" Phone No ��a -
Fill in fee simple Title Holder on next page(if different E-Mail R
from the Owner listed above) State or County License 9 V
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
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'l 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.
Signa "e of Owner/Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA �
COUNTY OF k q COUNTY OF I
The forgoing instrument was acknowledged before me The,forgoing.ins ment was acknowledged before me
this day of 20_ by thiscla day of201 by
(Name of person a nowledging) (Name of person knowledging)
i
-fSi at of-Notary Publi State of Florida) n ure of Notary Public-St a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification. - �: ._7GRAM
Type of Identification
Produced ',!-J�,„�,,, LASHAHNA Produced- Notary Public da NG M�� 1 ot'aY��s' LAShA018 ' �`� Notary publicNCommission No. '• My Gomr�Seal)` Commission No '.",commission - - ° Y Comm - Florida
Expires DecBonded through Natssn. �;ra;= 20,2018
,�Oj OF FlO�� commission C i
vee through National N tary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEANCE ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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