HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED NO
Date: ; ` �. ( _ Permit Number: NO(O •
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Building Perm t 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 Residential
(PERMIT APPLICATION FOR:
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Address: V r I l 3
Llgal Description:
Property Tax ID#: 6— 0tsn 000(O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
101
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itiona worktobepertormed under this permit—check all tat a )ply:
_Mechanical _Gas Tank —Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
TI tal Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ O U Utilities: _Se er. _Septic Building Height:
7Add ;ER/L USS e Vc� U f Name:
ess: �� e v ' c� Compan :
cK e State:_ Address:
Zip Code: 3\-Lc1.� Fax: City: State:
Phone No. 10 Zip Code Fax:
E-Mail: Phone N
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.
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 thegranting 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.
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Signature of Owner/Lessee/Contractor-as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAc \ \ STATE OF FLORIDA
COUNTY OF �+h ,�s� COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this�day of 20� by this day of 20_ by
Name of person making statement. 0 Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
( ' atur of Notary Public-St6le of Florida) (Signature of Notary Public-State of Florida)
`�� yP��, LASHAHNA INGRAM
Commission No. ..o �� Nota(Se01ic-State of Florida Commission No. (Seal)
f = ( w My Comm.Expires Dec 20,2018
.1,CC 1-10AD
Bonded throu(,h National Notary Assn.
REVIEWS. FRONT ZONING = "SUPERVISOR-{ PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7