HomeMy WebLinkAboutBuilding Permit Application All APPLICABLJ IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application Sr�tio9D ?
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Planning and Development Services perms
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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 TYPE:
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PEtOPOSED IMPROV MENT
Address: .S'8 �
Property Tax ID#: 3Y69 -&0.3-- O// 8- 00-'/ Lot No.
Site Plan Name: Block No.
Project Name:
DETAILED DES�RIPTtON O'F WORK � r � t�
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CONSTRUCTION INFORMATION'r � - n a
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:$ MO. X Utilities: _Sewer _Septic Building Height:
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OWNER/LESSEE �: " � _ � CONTRACTOR � � _
Name Name: a.c.�
Address: 8/:2 Company:
City: Stater. Addres2ss:,-Y
Zip Code: �9 9;t
Fax: City:�T' State
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Phone No. Zip Code: SY986 Fax: 7141•.2770
E-Mail: Phone No G/ -a 77 T
Fill in fee simple Title Holder on next page(if different E-Mailfbil/A e at-.Q ;Cal. Conn
from the Owner listed above) State or County License Ed 300-_5?5
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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R__SIGNER/ENGINEER: Not Applicable ` MORTGAGE COMPANY• (Not Applicable
Name: Name:
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Address: Address: !
City: State: City: State: I
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: City: 1
Zip: Phone: Zip: Phone: I
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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 thepermit 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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE,4-8SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO 3MTAIN FINANCING, CONSULT
WITH YOUR LENDER O AN ATTORNEY BEFORE RECORDING YOUR NOTICE OFC CEMENT."
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g ure of dwnW Lessee/Contractor as Agent for Owner Signat a of Contracto License Holder
STATE OF FLORA � C�it� STATE OF:FLO�RI� .,�
COUNTY OF COUNTY OF �ti,,
The for ping instru ent as acknowledged before me The fo ing in ant as ac nowledg before me
this day of g20K by this uday of t7��20 by
Name of person makinZta ment. Name of person ma��R
ment.
Personally KnownR Produced Identification Personally Known Produced Identification
Typ dentification Type of Identification
Pr duce Produced
{Signature of Notary Public-State of Florida) {Signature of Notary Public-State of Florida)
David Raym nd Prue
Commission No. V`��`i & - ( NOTARYP MdOmission No. G7(5X-_70Y"-- IDOWR
STATE OF LORIDA NOT�4RY PUB
STAT DA
REVIEWS FRONT ZONING ' PE" t" S VEGETATION SEA TUR CoimmnMGG2
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW R�
DATE
RECEIVED
DATE
COMPLETED
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