HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: --5 tc, Permit Number:
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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 Residential t�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: j
-
Address
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Legal Description:C_L17'�`ir
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Property Tax ID #: /30 �' U 2 - Lot No.
Site Plan Name: Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'CONSTRUCTION INFORMATION: - --- �_
itiona worko e e orme under is permit- check a apply: -------
HVAC ❑11 Gas Tank Gas Piping Shutters U Windows/Doors
_
11 Electric 0 Plumbing Sprinklers Generator L Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ L�-Utilities: Sewer[]Septic Building Height:
OWNER/, SSEE:
CONTRACTOR:
Name C C� Name:
Address: &_15 AV, C Ai 0 A Company: +
City: State:- Address:
Zip Code: Fax:City: Stater
j
Phone No .T 7 �o� - f7r • T� Zip Code: f� Fax Yaw
E-Mail: _ Phone No. T_ca
Fill in fee simple Title Holder on next page ( if different E-Mail:CE
from the Owner listed above) State or County License: _ G_ ����•}�-��v
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required-
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SUPPLEMENTAL`CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER
Name:_
Address:
City:
Zip:
Phone
_ Not Applicable MORTGAGE COMPANY: T Not Applicable
Name:
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City State:
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 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.confllct 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of weer/ Lessee/Cot
essee/Co r for as A en or Owner
STATE OF FLORID
COUNTY OF '
The f[Argoing instrument was acknowledged before me
thisday of�Bi✓ , 7i11by
Name of person making statement
Personally Known sef7!�: OR Produced Identification
Type of Identification
Produced
(Signaturl�of Notary Public- Staa-tpn�loriria 11
Commission 4.. "Qyy;);)b rf
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
S � 7
Signature of ntractor/Licens H Ider
STATE OF FLORI
COUNTY OF
The f raving insCCu ent was acknowledged efore me
thisday of 20by
Name of person making statement
Personally Known /OR Produced Identification
Type of Identification
Produced
1sianatu%4F N'6tary Public- State of Florida) II
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SUPERVISOR PLANS VEGETATION
REVIEW REVIEW , REVIEW