HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division
23W Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential 1-�—
PERMITTYPE: �al� 1
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PROPOSEDIMf'I(Q-
Address: IL I .Ito (%�5T-�, ---irI �{' 702 PSf 34gf!�-
Property Tax lD#: 3ZFZ2--2RO^ dOU —Ci/ Lot No.
Site Plan Name: I/�S�c ,3>L ,(. fir.. i /'� /"( 2 Z //n {' Z O 2- Block No.
Project Name:�f
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CONSTRUCTIO . 'RMATION:
Additional work to be performed under this permit— check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric k"Flumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ -C96 Utilities: _ Sewer _ Septic Building Height:
O CONTRACTOR:
Name Name:
Address: 22- t/i S IO 7 Company: li
City: �ii.c�/�..4 State: FL Addre s:
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Zip Code: :?Ogg 2 Fax: City.:,��, �14 Stater[
Phone No. 2 Z- / - Zip Code:,3-K4 SO- Fax:
E-Mail Ti7o/dz
FIII in fee simple Title Holder on neat page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is $2500 or more, a RECORDED Notice of [ommencem¢nt is required.
If value of HVAC Is $7,500 or more, a RECORDED Notice of Commencement is required. -
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Bole I MORTGAGE COMPANY: 4,Aot Applicable
Address:
Address:
City:
state: _
City: State:_
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMPANY: of 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 make99 no represegtatlon that is granting a permit will authorize the permit holder to build the subject str Bore
which is in con act wit any appllcaDDle Home Owners Association rules, bylaws or and covenants that may restrict or prohi�it 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 FA"RE TO RECORD A NOTICE OF COMMENCEMENT MAY t LT IN YOUR PAYING
TWICE FOR IMPROYFM YOUR PROPERTY. A NOTICE OF COMMENCEME ST BE RECORDED AND
POSTED ON THE JOB RE THE FIRST INSPECTION. IF YOU INTEND T T FINANCING, CONSULT
WITH YOUR LENOEB AN ORNEY BEFORE RECORDING TOIL CFMFNT-^
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Sign r o er/ a 'tractor as Agent for Owner
Signat f on Ucense Holder
STATE OF FLORIDA
STATE OF FLORIDA //
COUNTYOF-5��..c.!
COUNTYOF i
The forgoing instrument�� w,Fs acknowledg1bey°re me
The forgoin waSTcknowledgeeYore me
this d�ay/of y' 2O/ b
�instrumentn
this da of , a4 220 6
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Name of person making statement.
Name of person making statement.
Personally Known L OR Produced Identification _
Personally Known A__�OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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DATE
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DATE
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