HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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nuilicing rermix App icavon
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
PhKMi I APPLIC:A I ION FOR: To Select from dropbox, dick arrow at the end of line
PRopoSLU IMPROVF-MEN 1 LOCAI ION:
Address: �LQ�J �% 410)nLo (t
Legal Description:
Property Tax ID #:
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-
UI= l AILtU UESCKIP I ION 01- WORK;
i
CONSTRUCTION INFORMATION: _
Additional work oe ertormed under this perm -check a apply:
HVAC Gas Tank ID -Gas Piping Shutters
Windows/Doors
Electric Plumbing Sprinklers Generator
11 I
Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Z3 �� Utilities: Sewer Septic
Building Height
OWNER/LESSEE: CONTRACTOR:
Name
Address:
City.
Trp Code: 1 Fax:
Phone No.
E -Mail:
State:��_
RII in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
A ri, PA e r S
Company: Ou 3-a at A , r L4 s t em(� c'
Address,:l lF e �r_15S 6 1%i 11 -eenpp
I U PLT 9t, L v cog_ State: r�-
Zip Code: 3'f4 52. - Fax: 77a- .j -3
Phone No. I rla a 3 s- 3 2 3 2
E -Mail: e u S t n- I r s� s£ a o t C byr�_
State or County License: � 4 G O 5 [ F 10
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN IALC:UNS i RUC IIUN LIEN LAVH INFUIiMAI IUN:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
i Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
' BONDING COMPANY: Not Applicable
Name:
Address:
Address: i
City:
City:
Zip: Phone:
zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St- LLIcie County makes no iepreseniat on that is granting a permit xvill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, b�:laws or and covenants that may restrict or prohibit such
structure. Please consult :with your Home O%:lners Association and revie n your deed for any restrictions which may apply.
In consideration of the granting or this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance ttrith the approved plans,' he Florida Building Codes and St- Lucie County Amendments.
The folimk ing building per n -A applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, siximining pools, fences, Lvafls, 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 your Notice of Commencement.
Signature of OErTer/Lessee/Contractor as Agentfor Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA (� .
COUNTY OF St U tr-LL; COUNTY OF
i
The forgoing instrument was acknowledged before me � The forgoing instrument was acknowledged before nFe '
this day of i .�Q� lr�c 20 Lbs- I this day of tC:� 20 �� by
(Name of person acknc•_.ledging) + (Name of person acknowledging)
I /(�- .�•�^p' 7� //�� %�� �/ it � f/�� �/�/
•! -/`L `1:-e.�•J'�-:rte-i.i/ _. „ �%�1 �7-�;/'`_.' ' .!'�'�i .p .�j�- '��d'- �.�/'
(5i. -nature of Notary Public- State of Fsqda) (Signature of Notary Public- State -of Florid.
Personally Knoxvn OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced Type of Identification Produced
` (; I '�i� �� ,, l // �YPW
Commission No. ri �y ,.r L. =v` ° CHRISTiNEBEHWftmission No. �� 4P
af�° I * t
MYCOMMISSIONS 3052546
EXPiRES:Aped 2021 -c. )
f 0►T6� Bonded ThruMgetNatMSar es ---- rltR•a p HR $]:flflC i�.••� ---- 3
Revised 0; / 1 Si 2014* ` * MY C%- MISS10Y * GG 052545
EXPIRES: Apn,74,2021
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETA SEA TURTLE MANGROVE j
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE i
INITIALS
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