HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
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:
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PRQP05ED 1M1?ROUEMEN;C LQCATION4: F
Address: �j
Property Tax'ID#: 391(D , 5CD3 - Cpn 3S - OM -(_Q Lot No.-z2q _
Site Plan Name: Block No._
Project Name:
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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: 1 , 1 35 Sq. Ft. of First Floor:
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Cost of Construction: $ , 000 d Utilities: —Sewer _Septic Building Height:
OWNER'.'LESSEE' ' ` T � x K A
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Name t1-c��`�E�1r1 �� (�. , �r'nC h� Z Name: TFu
Address:S_7) Th r i n C X `P I GC e. Company: _1 c-tse Ter-nl�
City:{-4- ,IDi l,!!rC 2 State:_ Address:4_?5(.o �-,�e_e-4
Zip Code:3Ll 48 a Fax: City.CP8L< Stater
.Phone No. t}U7 - RoO - 4980 Zip Code:ZLI qKp Fax:
E-Mail: A-)J/; . Phone No-7-�a-LoU7- 1077
Fill in fee simple Title Holder on next page(if different E-Mail LAC e,amGl I . Cory)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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SU 'PLEIVI�NT ►L C NSTRU^CTftJN L,I N�I qW IN QRNIATItc
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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.
II 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 IMPROY ENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED E J SITE BEFORE THE FIRST INSPECTION. IF YOU T ND T OBTAIN FINANCING, CONSULT
WITH YO D OR AN ATTORNEY BEFORE RECORDING YOU OF MMENCEMENT.
Signature of Own%Lessee/Contractor as Agent for Owner Signature of Co for/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theo going inst ment was acknowledged before me The forgoing instrument was acknowledged before me
thi, day of ' 20a by thi4K day of 20tq 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 Produced
(A Qk o�Ikk
( ' to a of Notary Public- ate of Florida ) ignature of Notary Public tate of Florida)
Commission No. (Seal) Commission N �„Y •: =I =`- . ,(Seal)
r : : •. L ti i iAHNA INGRAM-RAHMING t-.: i•5 MY C ,A�AiMM1N
Y COMMISSION#GG 216060 ':°aF�4q"°` Fl 27506p
REVIEWS R 3r- E%PXRE4 MI w 2=VI OR PLANS W � An i tG ��22 ANGROVE
C!6�1��1La P"a REVIEW REVIEW b e" e REVIEW
DATE
RECEIVED
DATE
COMPLETED
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