HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: �I C)� �_ Permit Number: V1. A 14
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE:
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Aer MCP �FO
Building Permit Applicatiot�ez:,90
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Commercial Residential
[Address.:_ , Nam, es 9J41'a- // n 9f l�L
Property Tax ID #:- ' —�✓� c-, `-4�/ � ���47 `� O
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Lot No. Ow 2
Site Plan 1iTa. �' ��� Block No�
Project Name: >, °/ Z J"'4
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:
PCosf of-Cons'fruction:
0 ®�,
Sq. Ft. of First Floor:_
Utilities: —Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
OW RIBME:
CC�7 TRACTO
�Na m e��fP G cla q,� �lv� d
Name:
Address:) `7 A%Irez iTIC011
Company:,
City:- :E-jse"I 8-ce" State:.1r
Zip Code:A �' Fax:
t;l +
hone No. P-A9'62qy:19
Address:
City: i !` State:
..Zip.Code.'.. _ :: x:
Phone No
E Mail:-�Oy'i2,�,,7, e
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County Lic se
If value of construction is $2500 or more, a RECORDED Notice of Commencementxs required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name: -
Address: Address:
City:_ City:
Zip: Phone: Zip: I 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 concurrgncy 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
w.Tu vniLA I cuneo nD Au ArrnDiuFv RFFnDF DFrnDnimr. vniin NATIrF nF COMMENCEMENT_"
Si.gna ur_e of_Owner/J essee/Contractor as Agent for Owner
Signature of Cont
actor/License Holder
STATE OF FLORID
STATE OF FLORIDA
z
COUNTY OF (,kA Q��
COUNTY OF
I
The forgoing instrument was acknowledged before me
The forgoing instrument
wXanowl,edged before me
this S day oiC�� 20 by
NN 1 Jlfl
this day of20_
by
Name of person making statement.
Name of person'
ing statement.
Personally Known OR Produced Identification
Personally Kn n
Type of Iden ficaiion
OR Produced Identification
Type of Identification
Produced 1 �
Produced
(Signature of Notary Pu ' -
nature of No6ry
Public- State of Florida )
ELLEN VAUGHN
,,
Commission No. ��o1rp m,�%S st% f Plotid®•Notary P
leaIon. # CCU 270
b o mission No.
79
(Seal)
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My Cornml®I Explr
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REVIEWS
FRONT
,ZONING
SUPERVISOR
PLANS
VEGtTATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
vOIIt{11
DATE
COMPLETED
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