HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE.INFO
MUST BE.COMPLETED FOR APPUCATION:TO BEACCEPTED
i Date: ���01�' Permit Number:
Building Permit 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATIO'N'::
Address: (7 I t t To
Legal.Description: n 7 -3-1 N'0 All ���( J� S� l�� Cit-• .SW 11a L e SS
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Property Tax ID#: 1 0-1 3`1A Qyy Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCR`IPTION.OF 1NORIC:, .
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CONSTR( CTfONN INFORMATION:
Additional work toe e orme under this permit-c ec a appy:
HVAC 11 Gas Tank. ❑Gas Piping IiShutters. Windows/Doors
_Electric 0 Plumbing Sprinklers 1 Generator Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ (5 C)O , a'0 Utilities 11Sewer OSeptic Building Height:
OWNER/LESSEE: - ._CONTRACTOR:
Name C'_k(i S ri k2r Name: S haw n !,J"10
Address: Trt-e- —1312 Company: AW Ane
City: "fid- Pt�� State:f� Address:_ q�Ak i, �u S
Zip Code: Fax: /t//14. City: Wit- Stater
Phone No. aw, Ol— lq � Zip Code: �W Fax: �� —
E-Mail: Phone No. '?-7;1-- a 1
Fill in fee simple Title Holder on next page(if different E-Mail: - a 1_0 M e;n C GcSr.G4s�
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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`SUPPLEMENTAL CONSTRUCTION LIEN,LAW INFORMATION:
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 thepermit 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 exemptfrom 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.
S=ATEOF
Owner/Lesse tractor as Agent for Ow S' afar Contracto License Holder
FLORIDA . STATE OF FLORIDA
COUNTY.OF �� -^-���'� COUNTY OF
The forgoing instrument was acknowledged before me The forgaing.instrument was acknowledged before me
this__L:tday of
\ S2 Olem ber 2011 by this {`'day of 20-d by
Name of person aking statement Name of perso aking statement
Personally.Known�OR Produced Identifi n Personally Known �OR Produced Identification
Type of Identification Type of Identification
Produced �`�'� "Or Produced 5
7.
( gnature of Notary Public-State of Florida) `° o (S' ature of Notary Public-State of Florida) ic �z
Commission No.1 I' 6 S7 (Seal) 3, y Commission No.0 I �l� (S A!JM9r1J59O
s mREVIEWS FRONT ZONING UUM/15(p PLANS VEGETATION SEA TURTLE COUNTER REVIEW Re z REVIEW REVIEW REVIEWDATE o C RECEIVED
DATE
COMPLETED
Rev.8/2/17
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