HomeMy WebLinkAboutBuilding permit app ALL APPLICABLE INFO MUST BE C PLETED FOR APPLICATIONSQ BE,ACCEPTED
Date: - Permit Number:
Building Perl nit`Applica on
Planning and Development Services,"..
Building and Code,Regulation Division
130 g 0 Vir inla Avenue,Fort Pierce,i=L,34982' -
Phone:(772)'46271553 Fax:(772)462.1578 Commercial Residential.
P.EFM1T APPLICATION FOR;. To Select from dropbox, click arrow.at the end of line
1.
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Lego! Description: =3 �- �� - �� '�� `-�`• xi �... -%s^1 ��
Property Tax ID 4: "� l i Lot No.
t
t r I, L " Block No.
Site Plan Name: ff
Project Name:
Setbacks Front Back: Right Side: Left Side;
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�ti na wor to e e orme un- er t u permit—,c ec a apply: ;
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HVAC L_f Gas Tank, Gas Piping Shutterswindows/Doots
Electric ❑PlumbingSprinklers Generator Roof of pitch
'Total Sq. Ft of Construction: S :Ft.of First Floor:
Cost of Construction:$ s j ? Utilities: Sewer5eptic Building Height:-
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Name,
Address:
a t
City- "i �. � � r� _State: `-�- Address: �. '�� • � �,��i .-'� �-���" ' i
Zip Code: $ r Fax: City: �1 v"il t Stater
Phone No.. D^ -.— G -(�1 l i Zip Code: , Fax:
EWail: Phone No. �(*`'
Fill in fee simple Title Holder on next page(if different E-Mail: ", -U-) _o el � flf `i r Oe wl t
from the Owner'listed.above) State or.County License: A,r'0 0 T —S
if value"of construction is$2500 or more,a RECORDED Notice of Commencement is required,
SUQRLEIVIENT L CONS RUfrl'(ON'LIEN tAW 14F, �'
T ® �JIAi'(ON r x
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure I
which is in contlict 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 proorty.A Notice of Commencement must be recordediand,61sted on the jobsite
before the first inspectigr�%If you intend to obtain financing, consult with lenderr attorney beforecomrriencin w rk or,1'cordin our Notice of Commencement.
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Sign tur pdrJtessee/Contractor as Agent for Owner Signature gs:orftra or icense order`—
STATE OF FLdRIffA � r
STATE OF FLORIDA' x
COUNTY OF � 1 (.,'t COUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrument was acknowledged before me
this day of 3 i�(�G`I 20���by this�l day of 10" 20,)� by
Va
V"I
(NameFlf person acknowledgin (Name of person acknowledgin
(6ignature of Kcitar r Pu51ic-State of Florida) / (Rignature.of Nota;'Publ c-State of Florida)
f VionPersonally Known '-% OR Produce ntifica n " na ly Known� OR Produced Identific
pe-ofl ention Produced Type of Identification Produced
Commission No. QOSG 9{ �e ,,. Commission No. (Se
v e �, N.�� � cat3A oS�NgERG b
Revised 07 -Al
X
`��:REVIEWS FRONT ZONING SUPERVISOR. PLANS ' Y ION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS