HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
ry JUL 2 4 11110
•
PermltNng Department
Building Permit Application St. Lucie County
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:
PROPP9WNPRQAENT LOCATION:
Address: 5 4v e-
Legal Description: O!
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:4_ Right Side: _�� Left Side:
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6L e-e- , e a e f
Additional work to be pertormed 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: 160 -5 Sq. Ft. of First Floor:
Cost of Construction: $�:'>iSO. °� Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name M e Name:
Address: // Company:
City: (;f ie rve' State: L Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: 5c4 9>~romnic, @ 46L ,C&n Phone No
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.
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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 lender or an attorney before
commend-) work or recording our Notice of Commencement.
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Signat e ofnerltLesse Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF f5f COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this qday of 20_),�6y this day of 20_ by
mm kj�
Name of person m king statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica ion Type of Identification
Produced 21 Produced
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(Signature of Notary Public-S e of Florida ) 10�'�
(Signature of Notary Public-State of Florida )
Commission No. (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING SU �I PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW 0 E 2 REVIEW REVIEW REVIEW REVIEW
DATE Q o i c�LL
RECEIVED `"m � '
" 075
DATE co
COMPLETED
Rev.