HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02' `'� CJ Permit Number:
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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 ✓
PERM I APPLIC:A I ION FUR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMEN I LOCAI ION:
Address: o199.11
Legal Description:
Property Tax lD it: 3�O�S �pZ " ��nj — OOH — '"l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILF-0 DESCKIPIIUN OF WORK: I
L; \4,c i
CONSTRUCTION INFORMATION:
AcldTfional work to be er ormed un er t is permit - cock all that app-
DHVAC Gas Tank as Piping L_l Shutters Windows/Doors
OElectric Plumbing Sprinklers FI Generator F]Roof Roof pitch
Total Sq. Ft of Construction:' 1 ( Sq. Ft. of First Floor:
Cost of Construction: $ `-��P�JC) Utilities: []Sewer=l Septic Building Height:
i OWNER/LESSEE: CONTRACTOR:
Name L- Name: ' U C'T ( S
C Si'} (Lk l i1 C f)
Address: C9 v n rah Company: C u r, -T6 ri A r Li 5
! City: State: Address: 167 i 5 ��; l ; dG
Zip Code: C D:3:39Fax: City: [Pc%fir St . L c c i State: r
Phone No. (.D 11 _' c-�)�P — (0\00'- Zip Code: si+g5.2- Fax
E -Mail: Phone No. 11 a- 3.3 - 3
Fill in fee simple Title Holder on next page ( if different E -Mail: C u l t Ck i r s ti s C n i C c.;.oti. j
from the Owner listed above) State or County License: C% ? i
If value of construction is $2500 or more, a RECORDED (notice of Commencement is required.
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SUPPLEMENIALCUNSIRUC IION LIEN LAW INFOIiMAI[ON:
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DESIGNER/ENGINEER: Not Applicable
IMORTGAGE COMPANY: Not Applicable i
Name:
Name: i
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
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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 'stns commenced prior to the issuance of a permit -
St. Lucie Country 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, b�_ lar,s or ana covenants that may restrict or prohibit such
structure- Please consult :vith your Home Owners Association and review your deed for any restrictions tuhich may apply_
in consideration of the granting of this requested permit, I do hereby agree that I svili, in all respects, perform the nark
in accordance :kith the approved plans, the Florida Building Codes and St. Lude County Amendments.
The folimting building permit applications are ewemptfrom undergoing a full concurrency review: room additions,
accessow structures, sLvimming pools, fences, tva':ls, signs, screen rooms and accessory uses to another non-residentiai 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 your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner � Signature of Contractor,lLicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF , COUNTY OF _
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The forgoing instrument :vas acknowledged before me � The forgoing instrument was acknot;ledged before me
this 1_ day Df ,boo—L 20 lg bthis l day of 20 � by
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(Name of person ackncv,iedging j (Name of person acknowledging)
(Signature of Notary Public- Staff _ a ; ri-;a) (Signature of Notary Public -State of : brit -
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced + Type of identification Produced
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Commission No g3 tk CH EN No-
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: * MY COMMISSION 3 G 052Sd6 �7 i
N E)X[M#RES: ra
.2021
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Ended TIVU Btwgat Nowy swdines tam.••. g }j'
Revised 07-11-:V2014 * �� * t�Y coMM#sslou x Gc arts
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTIE iVi.ANGROVE i
COUNTER REVIEW REVIEW REVIEW REVIEW ( REVIEW REVIEW
DATE
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COMPLETE
INITIALS
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