HomeMy WebLinkAboutScanned DocumentsAll APPLICABLE INFO MUST BE CO PLETED FOR APPLICATION TO BE ACCEPTED
Date: � � �
Permit Number:
Building Permit Application
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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
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PERMIT TYPI=TAC:n(2f]n
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PROPOSED IMPROVEMENT LOCATION:
Address: `T
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Property Tax ID #: -"
Lot No._ --
Site Plan Name; (
Block No.
Project Name:
DETAILED DESCRIPTION OF WIDRK:
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CONSTRUCTION INFORMATION:
Adal work to be performed under this permit - check all that apply:
_Mechanicall _ Gas Tank — Gas Piping
T Shutters
Windows/Doors
_ Electric _ Plumbing Sprinklers
I
Generator Roof Pit
-
Total 5q. Ft of Construction:
Sq. Ft. of First Floor:
_
Cost of Construction: Utilities: _Sewer Septic Building Height: —
.� —
OWNER/LESSEE:
CONTRACTOR:
Name
Name:CIO
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Address: V'd Vd
City; I State:-
Company:
Address; SE Sol
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Zfp Code: Fax:
City: Ad
Stater
Phone Na. -
E-Mail:
Zip Code: 3 PFax:
Phone No r � 4
E-Mail W(
Fill in fee simple Title Holder on next page It if different
State or County License
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requited.
if value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
FSUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DE5IGNE
Name:—
Address -
City:
Zip:
NEER: , Not Applicable
State:
Phone
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
31 I FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
I Name: ;dame:_ _..
' Address: Address: _
City: City: _
�i Zip. Phone: Zip: Phone:
OWN ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicu`
I I certify that no work or installation has commenced prior to the issuance of a permit.
Fi St. Lucie Countyy makes na representation that is granting a permit will authorize the permit holder to build the subject structI.Ce
it which is in conflict with any applicable Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit atio:,i a,,
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 din 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" i
The following building I F g g permit applications are exempt from undergoing a full cancurrency review; room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use -
'"NARNIING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PA`17{•
I; TWICE FOR IMPROVEM0175 TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED
i POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
WFrH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOPC OF OMMENCEMENT." __ =
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _ by
Name of person making statement.
Personally Known
Type of Identification
produced
OR Produced Identification
1ignature of Notary Public- State of Florida I
Commission No. (Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED _
DATE: T
COMPLETED
WAN
Signature of Contractor/License Ho Ter �.._
STATE OF FLORIDA
COUNTY OF yd.
The ing instru t as acknowledge efore me
trday
this of 2q by
Name of person m:70R
ement,
Personally Known Produced Identifcation
Type of Identification
Produced_ . ; : IYC
_6_ _
(Signature of Notary P • ,atfl560AELTRANENA
hfY CDhIMA1 IQt� q FFW21Bq
Commission Na. EXPrRE�y7" 7019
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SUPERVISOR I PLANS VEGETATION SEATURTLE I IVIIANGRGUf
REVIEW REVIEW REVIEW REVIEW REVilt'1'r