HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,r
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Building Permit ApplicaLPermitting
EB 1 4 2019
Planning and Development Services De �rtm e n tBuilding and Code Regulation Division p2300 Virginia Avenue, Fort Pierce FL 34982 Cie C nty, FLPhone: (772)462-1553 Fax: (772)462-1578 Commercial Re
PERMIT TYPE:
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Address:
Property Tax ID#: j 570- 0 Lot No.
Site Plan Name: Block No.
Project Name: v� Iy 0 r
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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: Sq. Ft. of First Floor:
Cost of Construction:$ , t�oD. �� Utilities: _Sewer _Septic Building Height:
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Name Name: G J wnr�
Address: 3 �� llin.� vrt_�
Company:
Com y
City: e� State: 9 Address:
Zip Code: Fax: City: State:
Phone No. a �7,,l - D-Q3Z Zip Code: Fax:
E-Mail:��6/L/u T�Ita .Cusvt 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.
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S,UPPLEMENTfiALCO:NST{RUCTI.ONLI.EN LA11V INFORMATION m, hr k "
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE 4COMPANY: _Not Applicable
Name:_N'ka k'-e'L 0 iba.i c�u�t,� 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 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.
Signat of Owner/Lessee/Contract r s Agent f O�iCert. Signature of Contractor/License Holder
2�N 9
Off_.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � COUNTY OF
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The forgoing instrume
was acknowledged before o � The forgoing instrument was acknowledged before me
this day of I 11 20 by Q�W o this day of 20_ by
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Name of erson making statement. Name of person making statement.
Personally Know OR Produced Identificati Personally Known OR Produced Identification
Type of Identific ti Type of Identification
Produced `C Produced
(Z4_1UW IF.�i�- —
(Signature of Nota ublic-State of Flori a) U (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.