HomeMy WebLinkAboutBuilding Permit Application 7
Alec APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: "TPermit Number:
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Building Permit Application `
Planning and Development Services 5 2019Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST.. 69th 000.1+}PeFITtI }I19
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of
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Legal Description:�hi J(a j7 �I�Y L.S Q k5 _110J4 167-JA
Property Tax ID#: 0-667-052 0- QM--5 Lot No.
Site Plan Name: Block No. (��D
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to a er orme un er is permit-c ec a appy:
HVAC E]Gas Tank [_]Gas Piping Shutters []Windows/DoorsDoors
Electric F] Plumbing .Sprinklers FIGenerator
Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction: $ /,ka V
Utilities: Sewer OSeptic Building Height:
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Name har4 J. qoxtodl Name:
Address: 4
00- Company: 41411/(1
City: 'Fle State:�� Address: n LJMWILx_V.
Zip Code:_ ��� Fax: City: �. t"IGt'C'C� State:_/D
Phone No. Zip Code: ��Q8� Fax: 77,E-4lol'4Aa8.5
E-Mail: Phone No. r 72--Iy'&L g�Y
Fill in fee simple Title Holder on next page(if different E-Mail: 1ome,$i-,)n to QOI-CU'/9
from the Owner listed above) State or County License: EG f300 /&SA3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
ii 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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 your Notice of Commencement.
Owner/Lessee_/C!6niractor as Agent for Owner Sign Contractor/License Holder
FLO�IQA . - - STATE OF FLORIDA
COUNTY OF 154r. "r- COUNTY OF !S-N-. �-%)
The forgoing instrument was acknowledged before me T forgoing instrumentwas acknowledged before me
this day of C& CA 20-A by 11day of CI, C 26\7� by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifil ation Type of Identific t*on
Sig to I wrier Lessee/-ontri,
of
0 0 L
ig tu
STATE�FLORI DA
Produced L Produced
(Signature of Notary FPublic-State of Florida (Signature of NotaryPublic-�State of�F'
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Commission No,(SI*t ommlssionNo. V%9„P
c()MMJSS 16 V.[)ace t
101,
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REVIEWS FROM SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNT "
5
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.
Rev.8/2/17