HomeMy WebLinkAboutBuilding Permit Application ALL APAP CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:)V ��l� Permit Nu b
NOV - 1 2010
-Pii memo. _ Building Permit Applicatio
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County, FL
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
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Address:
Legal Description: U i�> �r 6L 1 Al: 4T C
LOT Z I
Property Tax ID#: 41;51 , Lot No.
Site Plan Nam , Block No._ -
Project Name: V
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Setbacks Front Back: Right Side: Left Side:
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i onal work toe performe un er this permit-check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof. Roof pitch
Total Sq.Ft of Constructi n Sq. Ft.of First Floor:
Cost of Construction:$ t Utilities:Sewer Septic Building Height:
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Name Name
Addre s: MOnr)_ Compan •
City: State v Addr ss: n �
Zip Code: Fax: Cit r State
Phone No r 1 (� Zip Code: '/ ax:
E-Mail: Phone No.
Fill In fee simple Title Holder on next page(if different E-Mail: (
from the Owner listed above) State 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 Countyy 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 approvedplans,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 intendt obtain financing, consult with lender or an attorney before
commencin work cirecordin o r Ic of Commencement. �� _
Signature of Owner/Les /Co Factor as Agent for Owner Signature of Contractor/Li n Holder
STATE OF
COUNTY OF FLORIDA t n July- STATEOUN Y CIF FLORIDA
The f r Ing ins ledg�before me The f ng ins ent was no edge efore me
this a of X20 h this 5 day of 0_ by
Name of pers n m king statement Name f pers making statement
Personally Known OR Produced Identification Personally Known. OR Produced Identification_
Type of Identification Type of Identification
Produced Produced
I (_fial
(Signature of Notary Public- ate of Florida) (Signature of otary Pu c-State of Florida)
Commission No. Commission No,� =
Y T L I CRUZADO
CRYSTAL MARIE CRUZADO •'= MY COMMISSION#FF993217
�': •'e MY COMMISSION#FF993217
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