HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nui
Building Permit
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
PERMITTYPE:
Address: .;r<
Property Tax ID
Site Plan Name:
aI
Additional work to be performed under this permit — check all that apply:
Mechanical _Gas Tank,*, " _Gas Piping _Shutters
Electric Plumbing _ ; Sprinklers _ Generator
Total Sq. Ft of Construction: 8 Y 0 Sq. Ft. of First Floor:_
Cost of Construction: $ 15 OO Utilities: _Sewer Septic
ition r 7 -J20
Permitting Department
St. L.t,IGle Colfnty, FL
Lot No. /O
Block No.
Windows/Doors
,A Roof i Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4/" ' � � "
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Name:
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Address; 3&c>y S Iv
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Company,Z -4�c4
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City: State:
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City o, f ^ vP. e r.Yt �yi Stater
Zip'IGode
Phone No > 2 6'
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mails _ n e 2e-A-W iL t 9 S V
State or County Licensee
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.
SUPPLEME AL GQ TRUCT &' IPN
DESIGNER/ENGINEER: Not Applicable
Name: ff Ze'_ ✓en
ORM TION.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 950 �� _ �.
s.
Address:
City: ovf LrG �
Zip: Phone ;?
State: G
"9'3 Zq
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY: _Not Applicable
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 BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
VTIFH YOUR LENDER OR AN ATTORNEY
� O
Signature f ner/ see/Contractor as Agent for Owner Signaturpof rai;KrAicense Hold
STATE OF FLORIDA STATE OF FLO
COUNTY OF T/j COUNTY OF
The forgoing instrum nt was acknowledged before me The for oing instrum was acknowledged before me
this _V day of , 20,9by this day of � 20_.Wby
Name of person making statera4rit. Name of person making stat6Qerl .
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification C� Type of Identification
Produced _ �.c 1 \/OLL/ 0 {r SS4:>�r'� Produced
n
(Signature of rygta
(Signature of
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A:U!!RE_YiB- HWAPHREY
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AUDREYB.HUMPHREY
Commission No. t
CAMMI(3fi"UGG3DO617
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Commission N •: •`
f11 O�iMISSION¢ Q0817
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EXPIRES. Mardi 6:2023 :,
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IFIES: Mara 6.2023
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REVIEWS FRONT
ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW
REVIEW REVIEW
RECEIVED
DATE