HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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P!anning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort pierce FL 34982
Phone: (772) 462-1553 Fax. (772) 462-1578
PERMIT APPLICATION FOR:
Address:1)4( i I ( 'rY) I t
Legal Description:
Permit Number:
Building Permit Application
LOCATION:
Commercial - Residential
Property Tax ID #:
Site Plan Name;
Project Name:
Setbacks Front— Back: Right Side: _ Left Side:
[DETAILED DESCRIPTION OF WORK: A/c CI,aAe e3u4 imom..
CONSTRUCTION INFORMATIfJR: _
Ll Ila MGl I IIIt" UIeGK a I I wat apply:
Mechanical _ Gas Tank ` Gas Piping Shutters
Wii
ElectricPlumbing `Sprinklers Generator
— ,Roof
Total Sq. Ft of Construction:
5q. Ft. of First Floor:
Cast of Construction: $— 4 Utilities: _Sewer _Septic Building
6WNER/LESSEE: CONTRACTOR:
Address: �S "
City:
State; r
Zip Coder I5 j Fax:
Phone No,
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Name: 0' S'-b` aa�
Company: es
Address:
City: Vero V e4e
Zip Cade: F;tVIC Fax: _
Phone No-7Z.2 - !�'7f'-;
E-Mail ;r ;
State or County License C 1$,
No.-LQ—
;k No. aL—
Pitch
State: k-
If value of construction is 5500 or more, a RECORDED Notice of CILM encement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY-:
Name: Not Applicable
Address: Name'
City; Address:
State: City:
Zip: Phone Zip: Phone: State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
�Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and inst
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
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restri
structure. Please consult with your Home Owners Association and review your deed for any restrictions which rr
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform th
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 addition accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-resi
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your payi
improvements to your property. A Notice of Commencement must be recorded and posted o
before the first inspection. If you intend to obtain financing, consult with lender or an attorne
Commencincy work or recording our Notice of Commencement.
1
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signature ntractor/License
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF Ir v i in
The forgoing inst e t was acknowledged before me The forgoing inst ment was acknowledged I
this � day of 20 by this � day of 20L
me of person acknowl dging
re of Notary Public- State of Florida )
Personally Known duced Identification _
Type of Identification ti�kYpL KIMBERLYMENDEZ Produced zo.W..
MISS
ION #GG234874
EXPIRES: J(UL 04, 2022
Commission No. •' Bondod th(64ffiI)tState Insurance
(Name of person acknowledging)
(tgn�atref Notary Public- State of Florida )
Personally Known g?L_ OR Produced Iden
Type of Identification
Produced .« ;;:;,I KIMRF
Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS
COUNTER REVIEW REVIEW REVIEW
RECEIVED
DATE
COMPLETED
ev. 772O34—
Bonded
Illation as indicated.
bject structure
or prohibit such
y apply.
work
mriai use
twice for
the jobsite
before
me
Y MENDEZ
7N #GG234874
L 04. 2022
t State Insurance
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW