HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED fir,
Date: �-1 lq Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (7;72)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMITTYPE:
PROPOSED INPROVEMENT LOCATION:
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Address: � D"13'z S ocy- gA - () Uoc.
Property Tax ID#: LASU-- Lot No.. _
Site Plan Name: �`�P�,�� j Block No.
Project Name: cl
DETAILED DESCRIPTION OF WORK:
[7CONSTRUCTICIN 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: 3co Sq. Ft.of First Floor:
Cost of Construction:$EADD•(�� Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
al R-
Address: �JE, ompany: l
City:,lem.sw State: AddresCCs:`` �i,�,�, i^,0A���c��c.� )
Zip Code: Fax: City: State:_'L
Phone No. � �aaa-Q,9a((1 Zip Code:��—`L��� Fax: jpq
E-Mail: QtC;V Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C& OSgl` \U
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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAWIIVFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _/Not Applicable
Name: I Name:
Address:! Address:
City: State: City: State:
Zip: i Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: of 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 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.
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Signature of Owner/Lessee Contractor as Agent for Owner Signature 6f ontractor/ ' ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF- MNa�,a COUNTY OF Mj!�IQL�;n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisAl 'day of 20-ft by this_K_day of far 2011 by
Name offferson making statement. Name ersg making statement.
Personally Known &e"' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produ ed Produced
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(Si u o a ic- a e o o i. )
^N datery Pualic St la c[Fi�ride
Notary y Ja Stets of Florida n�, idmberly,±c Hnlmea
Co s o. t y.blfaknes ( al) Co '�" My Commiasa:r-a t?117612MY O-n-GG sal)
or DOM 07M2 22021 117612 a x'.:;irea o71281"'
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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