HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�, 1 / /�
Date: c�" ZZ — PermitNumber: 1 `-'I,M • O S�t `-(
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Building Permit Application
i 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 APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:' MO 5
Legal Description:
Property Tax ID #: 33 Z1 Vo \
Site Plan Name: L, 00CL.SCD,r\
Project Name: I-Doo S v r\
Setbacks Front Back:
L.o fi
00D
Right Side: Left Side:
F]HVAC F]Gas Tank Da!
11 Electric F-1 Plumbing OSpi
Total Sq. Ft of Construction:
Cost of Construction: $ 2- 3,5 6
nIL-GnCCKau [ndpplY'
:
Piping Shutters
ars 11 Generator
S Ft. of First Floor: _
Utilities:Sewer OSeptic,
Lot No. 6 6 .
Block No.
Windows/Doors
Roof Roof pitch
Building Height:
F n
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Name
Name: C-0(44-5 I J4�>\
Address:i90�,
Company: > S
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City: orb S�
State:ET-
Address:31
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Zip Code: 3 Ltq-T-- Fax:
City:
State:P�
Phone Noj % Z. Zy Z lL 2 8
Zip Code: 9-9 1 Fax:
E-Mail:
Phone No. TI 2- g 1 Z. S_D
Fill in fee simple Title Holder on next page ( if different
E-Mail: o f • b 'J i
is .
from the Owner listed above)
State or County License: SL C- 2-3- �1-3
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it value of construction is $ZWU or more, a RECORDED Notice of Commencement is required.
MENTAL
CONSTRUE LIEN LAWrINF01MATION
P
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY: _ of Applicable
Name:
Name:
Address:
City: State:
Address:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: ocelot 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 vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License-Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTYOF
The forgoing instrument was acknowledged b fore me
this day of �L / -,P' . 20 1 �y
The forgoing instrument was acknowledged before me .
this day of �� iv.�, , 20 !`/ by
Name of person aking statement
OR
Name of person aking statement
Personally Known _ Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produce
Produced
YYCOIdMISSION 4212
N......,'' J05 BADM
woo I ON/GG 274212
,
(Sin ture of Nota
(Signa r rldDlie�
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev.8/2/17