HomeMy WebLinkAboutwoehleALL APPLI ABLE INFO MUST BEC PLETED FOR APPLICATION TO BE ACCEPTED
Date: V • r lolIs Permit Number:
Building Permit Application
Plooning and Development Services
Building and Code Regulation Division
2300 Virginio 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 LOCATION:
Address:
Legal Description;
M
Praperty Tax ID #: /��
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�._. _.vim_....._
Lot No.
Site Plan Name:
F. low
Block No. _
Project Name:
Fill in fee simple Title Holder on next page if different
from Owner listed .,•
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONST UCTION INFORMATION:
iti a wor to �e ormed�un- er t is permit- c
❑Gas Piping
ec a app y:
Q Windows/doors
HVAC Gas Tank
Shutters
Electric FlPlumbing F]Sprinklers
(_I Generator
Roof Roof pitch
Total Sq. Ft of Constructi n, 1
Sq. Ft.of First Floor:
Cost of Construction: _ 1 �..._ Utilities:
U Sewer Septic
Building Height:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
110AMS
F. low
St
Zip LI ax;
Phone NJ
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,
Fill in fee simple Title Holder on next page if different
from Owner listed .,•
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ _ Not App
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:____
Zip: __
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:_
Address:
City:,
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 t�ac obtain financing, consult with lender or an attorney before
commencine work, ffAecordinE vour �f � of Commencement. ., __. _.._
Signature of Owner/ Less/Cofractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF M>KM1-1 I1V
The Ding in led efore me
this day of _ , 20 y
1
ame of Pers ma ing statement
Personally Known V OR Produced Identification
Type of Identification
Produced
paa_&
gna ure of NotaryPubli ate of Florida )
Commission N -Fq4-- ?� Seal)
CRYSTAL MARM CRUZAOC
REVIEWS I `N NT EX4IZ1W#W 25. f i�%PE*ISOR
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of Contractor/LiptnWHolder
STATE OF FLORIDA ' ^�
COUNTY OF N 1 KA
The 1pr1ling in i s ledg efore me
this day o 20 Y •
Name of _ern ma ing s atement
Personally Known V OR Produced Identification
Type of Identification
Produced
. � M t J'_)i
(Signature of Notary ub i - Stat f Florida)
Commission � IwSeal)
. cvRTAI MARIE CRUZADO_