HomeMy WebLinkAboutApplicationALL APPLIC BLE IN o MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: IO� acC - Permit Number:
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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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal pescription: (xolaL�4L�
Property Tax ID #:
Site Plan Name:
Project Name:
b( 6'
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
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7C ��
CONSTRUCTION INFORMATION:
L ZHVAC L_J Gas Tank
11 Electric 11 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
uncler inis permit — CneCk a
E]Gas Piping
Sprinklers
LJ Shutters Windows/Doors
11 Generator Roof Roof pitch
S Ft. of First Floor: _
Utilities: Sewer [] Septic
OWNER/LESSEE: CONTRACTOR:
Name
Address:
City:r
Zip Code:
Phone No,
Fax:
State: ISL
Name:. J
Company:
Building Height:
Haaress: of
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i
t
yState:
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Zip Code: Fax: o� �f
E -Mail: Phone No. -��
Fill in fee simple Title Holder on next page ( if different E -Mail: i V,'.Ul•G
from the Owner listed above) State or County License:+r'��tl7/' /,tom
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LEEN LAW ENFORMATl4N:
DESIGNER/ENGINEER: Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address: _
City:
Zip: Phone:
State:
Not Applicable
TMORTGAGE'COMPANY:
Name: _
Address.-
City:
ddress:City:
Zip:. Phone:
BONDING COMPANY:
Name:
Address:
City: _
Zip: Phone.
Not Applicable
State:
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 Nome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Piease consult with your Nome 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
Icommencing work or recording your Notice of Commencement.
r
Signature of caner/ Lessee/Co r oras en or Owner
STATE OF FLORID
COUNTY OF '
The forfrd'
g instr�m nt wa acknowledged before me
this ay of 26 y
Name of person mailing statement
Personally Known 1.,f' OR Produced Identification
Type of Identification
Produced
(Signatu4of Otary Public- State n-f`FIorirla 1
Commission
f
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
Signature of ntractor/LicensAer
STATE OF FLCII�RlqA
COUNTY OF_
The fog inst,Cum nt was cknowledge efore me
this day of Z y
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
I Ic onatub4I�ttary Public - State of Florida )
0Q? ;130 M �oP4 0 GO 284M .&►axe 26,
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SUPERVISOR PLANS VEGETATION I
REVIEW REVIEW REVIEW