HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: L 11? r o Permit Number:
4 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 LOCATION:
Address: Sas
Legal Description:
AWK ar It 'al Bi L ja Loi Zs
Property Tax ID#: [Q [Q.. 17'�LE ppQ_(Q lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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54 (o [cul WaA -
CONST LICTION INFORMATION:
Additi9fial work to ba orme under this permit—check a app y:
HVAC flas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 12 Generator Roof
Total Sq.Ft of Constructiorn�:,,� Ft.of First Floor:
Cost of Construction:$ "t WD• UtilitiesSewer nSeptic Building Height:_
OWNER/LESSEE: CONTRACTOR:
Name Name: �C
Add ss�L (a- a/ Company:
City: {Z State:_Ff- Address:
Zip Code: 3VA52- Fax: City: kfb t(r-t State:
Phone No. Zip Code: Fax:�"1�--{{(�•a7,37
E-Mail: Phone No.JJA-- 4(al-4ILI (
Fill in fee simple Title Holder on next page(If different E-Mail:by [[e,ar, op �j"-wm
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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.
A;4�4�L_7 /Z"
Signature of Owne'QLenq>ssee Signature of Contractor/License Holder
STATE OF FLORIDA ( �, STATE OF FLORIDA
COUNTY OF ' `^'' COUNTY OF
The forgoing" ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of ctnLb� 20 Ebyj thisJay of NAil�t1YLb2� .20_.IA by
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to"
(Name of person acknowledging (Name of person acknowledging)
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(Signature of Nota blit- a of Florida) (Signature of Nota��OR
-State of Florida)
oral Known V OR Produced Identification Personally Known Produced identification
Pers IY
T Type of Identification Produced
Type tHRISTINE J.COMWLL
�� rCHRISTINE J.C4M
Comm Nohry Pu01iC' of Commission
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS