HomeMy WebLinkAboutbuilding permitAll APPLICAB FE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3% D-� C% Permit Number:
IMI I
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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_
PERMIT APPLICATION FOR:
Address: i}`1Cia#ty , Fl,
Legal Description: a,._► as vl Q
Property Tax I #: 3, — S o 3 - 0 0 9 % — 0 00 — ir Lot No.01, �5
Site Plan Name: Block No.
Project Name: cS /YR n e l
Setbacks Front Back: Y __ Right Side: Left Side:
_Mechanical — Gas Tank _ Gas Piping (Shutters _ Windows/Doors
_ Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ,ti / d d Utilities: — Sewer — Septic Building Height:
Name l�a f" mG( Name:
Address: 9qo f i Company: C ci v iJ
City: _ ICr c _ State: Address: dZKZ,,
Zip Code: 3 yg�r1 Fax: A14 City: t Cc Stater
Phone No. D - f f 2 Zip Code:Fax: c! S"
E-Mail: Phone No 7
Fill in fee simple Title Holder on next page ( if different E-Mail TOf'✓], ,tlFcLi4Q [ate
from the Owner listed above] State or County L1censeee /VS-,0e
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Name' —7y, Not Applicable MORTGAGE COMPANY: y Not Applicable
Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: __X Not Applicable BONDING COMPANY: ilNot Applicable
Name: 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
cor_ mmencing work or recording your Notice of Commencement.
re of OiarferTCessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF S�- Luc�t
The forgoing instr4rnenT was acknowledged before me
this J'!_ day of aQgSV 20 2L.', by
Name of person making statement.
The for oing instru ent was acknowledged before me
this day of SAGAS" i . 20 9-0 by
Name of person making statement.
Personally Known OR Produced Identification G .�� Personally Known OR Produced Identification L---"
Type of identification Type of Identification
Produced yL1C4;"6,iy (XWeI12- Lllr�119K Produced Uelu
Nature of Notary Rubjlce`sta�
Commission No.
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DATE
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