HomeMy WebLinkAboutBuilding Permit Application u
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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COUNTY '. ,:, �ih J
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Building Permit Applicatione�.r�gotar e41#0nt *��pdpr
Planning and Development Services �10ty POC
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982X '
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: .,
Address: 3 �? oc..g_ 1
iA
Legal Description:
Property Tax ID#: tU 05- 1 ' 3- bud Z' Ox�(--)— 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK , ,
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CONSTRUCTIO•N INFORMATION
Additional work to,
Mbe performed under this permit—check all hat apply:
HVAC u Gas Tank Gas Piping Shutters
pg — Q Windows/Doors
IZElectric ❑ Plumbing I Sprinklers El Generator El Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 00. c.° Utilities: Sewer Septic Building Height:
OWNER/LESSEE ,t '•', CONTRACTOR:
Name Vl\AVIA {iyv� e„,S ..- Name:
Address: 33.\ W ZO� 7-eCompany: VA S c. C e
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City: ern.% C\ l3 o VAS State:-FA Address: ‘TD CO MOI.OI csJG .1 i
Zip Code. 305.p Fax: City: `--1 State: F(
Phone No. Zip Code: 3-952 Fax: Z,--1-4(2(—17USS
E-Mail: Phone No. --f-17,-4LQk- L1 JA
Fill in fee simple Title Holder on next page(if different E-Mail: Xstl[Y Sr - 1(..._.(g Gen , CzyNA
from the Owner listed above) State or County License:EC.k TDCol X4-3 '
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 1
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SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION ` z
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 1
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 your Notice of Commencement.
Signat'- o Owner/Lessee ontractor as Agent for Owner Signatu - ,f Contractor/License o der
STATE OF FLORID i � SCOUNTY FOFORID — �� _
COUNTY OF . ._ __
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this ty day of ,-,20_ by this ! ay of ,20 / -by
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
Prod -d Prod9 d
k A} & a‘ riy-.. ) ix„it..
/ (S gn.Wre of Notary Pub k State of Florida) Signature of Notary P;blic-State of Florida)
{om ission No. (Seal) Commission No. (Seal) :.•
L`S 1"tt ',Ito oS fioocia � aV a _., J1. 2t
�.�totty, Y .•,,;c;<.--7-',-- -', - lar 20
PY Pzfi;,, S�O.cfy _ li 20 �' niJ ty�)'L r t 2'
REVIEWS FRON ,ZONII�7G 'n c SUPERVISOR. '• t> PLANS VEGETATION I :,�E ftTLE'0`�'t s i�(VGROVErV p,sr.
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COUNTER�p. REVIE11Pl `fpUt,�'I-REVIEW,-is" �iREVIEW REVIEW •.-7).;RE, � °n---1 ° VIEW
DATE <.,. o�c.. .- �,,. _ :- "'
RECEIVED
DATE
COMPLETED
Rev.8/2/17