HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c�° �' ,� PermitNumber:
RECEIVE
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_. Building Permit Application DEC - 3 .241$
Planning and Development Services
Building and Code Regulation Division Permitting p Dartment
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial curt
PERMIT TYPE:
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Address:.
Property Tax ID#: f _T(4 f C90 2 F Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit-check all that apply:
_Mechanical Gas Tank —Gas Piping _Shutters -,/Windows/Doors
Electric _Plumbing Sprinklers _Generator (�Roof Pitch
Total Sq.Ft of Construction: S Ni Sq.-Ft.
of First Floor: 2L0(- I e e- V
Cost of Construction:$ . 00 Utilities: ti!Sewer —Septic Building Height:
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Name Name:
Address: Wl N1W vlt"i Nod.,.. Company:
City: � _ '. Stater Address:
Zip Code: gi '� Fax: City: State:
Phone No. 1712- 70-1- P Zip Code: Fax:
E-Mail: C `- Phone Na
Fill in fee simple Title Holder on next p e(if different E-Mail
from the Owner listed above) State or County License
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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 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 uses._.
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. ou intend to obtain financing, consult with lender or an attorney before
commencing work or recokdi6g your Notice ncement.
Signature of Owner/Lesse /Contractor as Agent for wrier Signature of Contractor/License Holder
$ m�i
STATE OF FLORID Xo o STATE OF FLORIDA
COUNTY OF Z" A COUNTY OF
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The for oing instru nt was acknowledge efore s The forgoing instrument was acknowledged before me
this ' day of�- ,20��by this day of ,20_ by
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S` �/�..•V 0.J �J i / L U,
Nam f person making statement. r Name of person making statement.
Personally Kno n OR Produced Identification `'/ Personally Known OR Produced Identification
Type of Identifica ' Type of Identification
Produced dr- Produced
�"wl_ �5��iqL
(Signature of ry Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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