HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: t
RECEIVED i
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__.._._ Building Permit ApplicatiFnOCTPlanning and Development Services cie County, Permimri7
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMITTYPE:
PROPOSED IMPROVEMENT LOCATION
Address: Q %a L4 lzt� zo
Property Tax ID#: Lot No. `
Site Plan Name: Block No.
Project Name: u. A:L A:�hj zaQA�
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
J( Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
.0WNER/LESSEE CONTRACTOR.
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Nam Name:
Address: d Company: � 4Ae-,.
City:g ra, PAIU� State:_ Address:,k#3n,� / ..2 /O.] - B
Zip Code X0.6 1 Fax: - City: ./-�.clet� State:Al
Phone No. Zip Code: 3J1983 Fax: 'Y'6/- J 22S
E-Mail: Phone No-41L A Q 172
Fill in fee simple Title Holder on next page(if different '
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from the Owner listed above) State or County License LG /3 DD-'5�.�9
651-02 AfR7,5'
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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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: X 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 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 SITE ORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR Apr ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMEN T."
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Signat f Owner/Lessee Contractor as Agent for Owner Signature df Contractor/License Aolder
STATE OF FLORP� STATE OF FLORIDAr
COUNTY OF >4= Z COUNTY C 3f
The forgying instru nt acknowledged before me The for ng instru nt a acknowledged before me
this ) "ffiay of 20 l`�by this ay of 20 by
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Name of person making statement. Name of person making state ent.
Personally Known_AZOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ProducJI-li Ie
(Signature of Notary Public-State of Florida) (Signature Notary Pub ic-State of Florida)
David Raymond rue
Commission No. — c��2 �o1►�a NOTARYPUBLI Commission No.(7��t�'-7os2 I�av�dRaymI
�! +STATE OF FLO IDA T' o OTARY P
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£STATE OF
s�HCE 19� Expires 1/261 023 �� om REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU LF FROMRa
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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