HomeMy WebLinkAboutBuilding Permit Application s` �l
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d 1,
Date: Permit Number:
,� - 7 RECEIVED
CF L 0 RI
• JAN 2
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1
9
_. __._. Building Permit ApplicaM
ucie Co,,hrkf f'@P►ifttj�
Planning and Development Services - -- . . 9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT TYPE:
40�' S�' •n @5
PROPOSED INPROVEMENT LOCA ON:
Address: 2-110 r° c c qcz
Property Tax ID#: a`i1�.1' ro 0_1— a 4 wi. 043(3— (o Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:- /' P
Ck AV
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CONSTRUCTION INFORMATION:
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: 6 O Sq. Ft.of First Floor:
Cost of Construction:$ fj Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Gt Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. 772 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(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:
FEESIMPLE 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 use,,,!-
WARNING TO OWNER:Your failure to Record a'Notice.of Commencement may result in your payingAvyice 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 bran attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner Lessee Contractor or Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF Sk_ �,ocre COUNTY OF
f
The orgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this`�3 day of'3�o,h ,21A_J, by this day of .20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced `- L Produced-
. � I�
(Signature of Notary Pub c-State of Florida) ature of Notary Public-State of Florida)
Commission No. dOS--x eaIbEANNAMAMEGTVENS o fission No. (Seal)
My COMMISSION#GG 022
IRES.December 16. 20
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REVIEWS FRONT L;,- R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev.9/26/18