HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� j
Date: I Permit Number: -All ` t tA%
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
PERMITTYPE:
Address: " OO Tu v i n ba b S `Teri 82:- a05
Property Tax ID #: OC )Wvvv ' 9 Lot No.
Site Plan Name:: Block No.
Project Name: 1 -cam �i 1-e—r me-Az-
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AddrMechanical
I work to be performed under this permit- check all that apply:
_ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric —Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: I 'I
Cost of Construction: $ 51 sm
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
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Name I ,%-P—+Z
Name:
Address:_3100 TW I`D LG k S Tesr
Company-_�70,f_'
City: T-k-,? ,e-rc_Q_ State: F!
Zip Code: -_:4ci 51 Fax:
Phone No.'-) nQ --9 ` 7 ` (33Lp
Address: 49tD ZSCAD Mt">W7)y S+�-
State:(
Zip Code: ?,H (i &L-i Fax:
Phone No-)-) `Z-(O'—)- 1O-)-7
E-Mail:'t"_Ue+tCLNPLLC e, Qcy1 -i 1, W M
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail.`A t
State or County License
1 l
IT value or construction is ,lLSUU or more, a KtGUKUtU Notice of commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
Name:_
Address:
City:
Zip:
GINEER:
Not
icable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State: City: State:
Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY:
Name:
Ad d re!
City:_
Zip:
Phone:
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 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 THE J�B SITE BEFORE THE FIRST INSPECTION. IF YOU IN 'EN TO OBTAIN FINANCING, CONSULT.
WITH Y _ EN OR AN ATTORNEY BEFORE RECORDING YOUR NO E COMMENCEMENT."
Sig w / Lessee Contractor as Agent for Owner
Signature er
cerise Holder
STATE OF FLORIDA
COUNTY OF 11�&,
STATE OF FLORIDA
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X, . 2,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument
was acknowledged before me
this day of 20_ by
this day of
20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known
OR Produced Identification
Type of Identification
Type of Identification
.Produced
Produced
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(Sig tur of Notary Public- StIte of Florida)
(Signs re of Notary Public- Statb of Florida )
Commission No.
Commission No.
( ° . "' �R"L�IM RAM -RAMMING
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DATE
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DATE
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