HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CO "TED FOR APPLICATION TO BE ACCEFMt '']]�,l ((�� j�`U �]
Date: Permit Number. ah -1 - b l `b
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYPE:
Address: A "
Property Tax ID
Site Plan Name:
Project Name:_
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Building Permit Application
Commercial
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Residential
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Additional work to be performed under this a rt-the all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
r/Electric _Plumbing _Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction:$ Utilities: _Sewer _Septic
Lot No.
Block No.
Y wrndows/I
✓ Roof
Building Height:
S? IA�
Pitch
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CONTRACTOR
Name f flfG �/?Ni�%7 0
Name: .4S43,0 flue
Address:op G/%r
Company:_� E> J -r /✓S DI/1/
City: PD/i'T 5 r 4 d o/ State: Z-
Address: ro w/—
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Zip Code .3z/ 9Jr2 Fax:
city. ��, P -e- State:':' �
Phone No,f-2 S - 4e66 - QO $9'
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Zip Code: 31 F1 Fax:
Phone No 7 7 L T f 14W f
E-Mail: P",, / iy /d7 /9 (2 /BOG C-OA
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
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If value of HVAC is $7,500 Or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
0
_ Not Applicable
ON.
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
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,
accessorystructures, 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
WITH YOUR LENDER OR.AN ArrORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Signa ure of er Le ee ntractor as Agent for Owner
Signat Co ct /L�cJe e Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 54- LL) —
COUNTY OF1}—
The forgoing instru ent was acknowledged before me
The forgoing instrumtn�t was acknowledged before me
this VZday of �1, 20�Jby
this day of 1(IOJ /(i 20_701y
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 2)L/
Produced l/
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( ignature of Notary Pu - State of Florida j
„(Sifrlafure of Notary Pub lis. gate of Florida)
Commission No. (Seal)
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