HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST, BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �-,2q- o?,00 Permit Number: I"1®�' CJl4J
Building Permit Application
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
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PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address:
Residential
IN,
Property Tax ID #: 541q J 3 Q DoR3 Y 0yl/c-)-_ Lot No.
Site Plan Name: Block No.�
Project Name:
DETAILED DESCRIPTION OF WORK
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CONSTRU,CTIO,N 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 ofiConstruction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:
OWNER%LESSEE
:CONTRACTOR•
Name QOCL/W Euu
Address: i iq' JWF
Name:
Company:
Address:
City: r�2ST LAC ( State: �
Zip Code: a0GJ Fax:
Phone No. 17#77
E-Mail: !
City: State:
Zip Code: Fax:
Phone No
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
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.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: _ Not Applicable
Pp
Not Applicable
MORTGAGE COMPANY: _
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: i Phone
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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 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 JOB SFFE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR 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 ��y_o
COUNTY OF
The fpping instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
thisC'1 day of 20 by
this day of , 20_ by
�-Y
Name of persi n making statement.
Name of person making statement.
Personally Known OR Produced Identifications
Personally Known OR Produced Identification
Type of Identifica * n
Type of Identification
Produced k L
Produced
at re of Notary Public- Stbte of Florida)
(Signature of Notary Public- State of Florida )
Commission No. _---�—q— ���
NA RAM'RAHMWG
Commission No. (Seal)
YPlio'•, LASHA
..:G
COMMISSION # GG 275060
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COU
EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/7/19