HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300Virginia;Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: (�'� S O P71J-T- ,�
Legal Description:
Property Tax I,D#: D Lot No.
Site Plan Name: Block No.
'Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-checkall that pp y:
imechanical _Gas Tank _Gas Piping Shutters.— _Windows/Doors
Electric _Plumbing _Sprinklers Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. o First Floor:
Cost of Construction:$ P Q �. $0 Utilities: —Sewer _Septic Building Height:
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Name I-A Vi5:-,7 Sof A .. L� Name: CtSCO Go 3 a
Address:(Q9 (p�' M103 '_, -- Compa y: �1 S G� P1't f2i
City: 1�J��.. State: Addres : ) 3 L-A-..t rAl71►11 PD,
Zip Code: (q(9_-V Fax: City: G 01-0)1 State: f:icl
Phone No. .% �-Q, 333 L Zip Co e: 3`1 02/6 Fax:
E-Mail: Phone lo SZo C- V 3 0--X)
Fill in fee simple Title Holder on next page( if different E-Mail ce A,7
from the Owner listed above) State o 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
commencing work or recording our Notice of Commencement.
Signature of wn ssee/Contractor as Agent for Owner Sign ntractor/License Holder
STATE OF FLO DAc Q \ STATE OF FLORID4
COUNTY OF Jit . COUNTY OF &
The forgoing instru nt was acknowledged before me The fgentoing instru s acknowledgge�d before me
this day of 204 by this day of wa2b]6_ by
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(Name of person acknowledging), (Name of person acknowledging)
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(Si nat ecLrNotaryl blic-State oO Florida) (Signat o -Not P,pyic,,State of F)ori a)
;r y (Notary .k"
Personally Known.. O,R Produced Identification] Personally Known -•: R:P�"reduced'Identification
_
Type of Identification, ,,"��., �yv �'-ri'�A INGRAM Type of Identificatl i�rF o�°; Commission #FF 177
s c 0F Bonded through National ilotary Assn.
Produced �n, 2 Notary Fuulic-state of Florida Produced _
Nom: •_ My Comrn. Expires Dec 20,201 S K
Commission Na '�;� o�° Commissi(.Seal)F 177249 Commission No. (Seal)
bonded through National ilJotary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014