HomeMy WebLinkAboutBuilding PermitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Permit Number:
Building Permit Application
V
Commercial Residential
Address: 17 12
Property Tax ID #: s 2 L7 " 0030 0520 Lot No. 25
Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
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: Sq. Ft. of First Floor:
Cost of Construction: $ ..z 5- Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 3 �11 _, Q-1-
Name: 107/41- 3'T0YAV ` --"
Address "' r�
Company:
City: 0. Q State: VJ
Zip Code: ^2 2. 1.'frj _ Fax:
Phone No.
Address: 4�()_R lu -ar ll. `5bt y f+v e,
City: 'P S I- State: �L
Zip Code: 3 '1 43fi Fax:
Phone No "772 --777 C060
E-Mail:
Fill in fee simple Title holder on next page { if different
from the Owner listed above)
E-Mail eJ_,_1` 4 �Vl t Q 'qA kfoo CZ M
State or County License
tr vague or construction►1s :>LWU 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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: � Not Applicable
................
MORTGAGE COMPANY: Nat ApP livable
.
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 mattes 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
iVIiI'H YO ER OR AN ATTORNEY BEFORE RECORDING YOUR NO OF COMMENCEMENT."
Signature of Omer/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY Of
STATE OF FLORIDI A_�G
COUNTY OF J-
The fq oing instrument re cknowledg efore me
this ay of _, 249 by
The #or Ding inst�me t was acknowledged�efore me
this day of 21 "yf by
Name of person makingg scant.
Name of person malting statement.
Personally Known O Produced Identification
Personally Known OR Produced identification
Type of identification
Type of identification
Produced
Produced
A
( afore of Notary Publi 7 of Florida
t�,�. irik 1V6�
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(Signature of Notary Pub c S��,pf Florida )
Erllc A#errwga
Commission Na. _ _ Co�ion # GG101 4
pires: May 4, 202I
_
Commission No. - y = SiOR GGf01442
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,� es: M 4
Expir May , 2421
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DATE
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DATE
COMPLETED
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