HomeMy WebLinkAboutUntitled All APPLIC ' LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SII �I
RECEIVED
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- - � . ... Building Permit Application 2=4
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
PERMIT TYPE:
PRpPO5ED (NPOII.EMENT_LOCATION .
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Address:.- �J e, GL �� � ��el I LK
VS�
Property Tax ID#: �i! " c�l�� Q ®� g Lot No.
Site Plan Name: Block No.
Project Name:
DETAILEI -PE5CRIFTION OF WORK
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G ' i L f' I
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�C(3NSTRtlCT10NINFOR ATION §t ;u
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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 V/Roof '��/ Pitch
Total Sq. Ft of Construction: O 54, Sq. Ft. of First Floor:.
Cost of Construction: ` Utilities: —Sewer _Septic Building Height:
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OWNERjEESSEE. ' i...
CONTRACTOR
Name M4A eL Name:
Address: 5:60-'- 63P. c nQ` 6f1 (LWI Company:
CityVD( State:State:AL., Address:
Zip Code: oL �� Fax. City: State:
Phone No.-) ,Zip Code: ;Fax:
E-Mail- E � V Cc-O') Phone No
Fill in fee simple Title Holder on ne 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.
SUPPl.EI1IIENTA�CQNSTRUCTIC}N.�.IEN 1.AW 1l�FQRIVIATlON
.',c". .a '`•�. .._ .w .,fin. Fa ... _.'_:. ��.�: ;,.a.. ,. -.'.+ ;°:'_ `'r
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 use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvemeo your property. A Notice of Commencement must be recorded and posted on the jobsite
before the rst i pection. If you intend to obtain financing, consult with lender or an attorney before
commen, in wo r ecordin our Notice of Commencement.
I
Signatr fLOr/Lessee/Contracto s A nt for Owner Signature of Contractor/License Holder
STATE F RIDA STATE OF FLORIDA
COUNTY OF / COUNTY OF
The fgg,r� ing instru en was cknowledge before me The forgoing instrument was acknowledged before me
thisqday of 2011 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 Identifica ' Type of Identification
Produced L li Produced
i
(Signature of Notary Pu - (Signature of Notary Public-State of Florida)
""v6.V P46 i
KAREN S. NIELSEN
ar° State�f�F��1Qrida-Notary Public
Commission No. �= Corrfr?f lon #GG 20', Commission No. (Seal)
oa°c My Commission Expires
June 12 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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