HomeMy WebLinkAboutBuilding permit appALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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: I
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j PROPOSED IMPROVEMENT LOCATION:�-
Address:
Legal Description:l31
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Property Tax ID #: Lot No.
Site Plan Name: t 01- Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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'CONSTRUCTION INFORMATION:
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o wor o e e orme un er is perms —c ec a appy:
HC Gas Tank ❑Gas Piping Shutters11 Windows/Doors
U Electric 0 Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �i�� % Utilities: Sewer — Septic Building Height:
OWNERAESSEE:
CONTRACTOR: -
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Name
Name: �`�
Address: t 1
Company: {ir\ . Y
City: State:
Address:
Zip Code: 't�> Fax:
Cites y. _ � Qi11[� State:
Phone No. l '�)
Zip Code: %;Zkuc) FaX711Q_ '
E-Mail:
Phone No,�P� _ _xj
Fill in fee simple Title Holder on next page ( if different
E-Mail:.
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:` - —
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
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 apermit 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 restri.rtions 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
commencing work or recordingyour Notice of Commencement.
Signature of wner/ Lessee/Co r tar as A en or Owner
STATE OF FLORID
COUNTY OF
The f raving instru twas acknowledged before me
this day of_ , 2i7- 1 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(SignaturPof Notary Public- State ni"FJoriH;i 1
Commission
Signatu4ofntra4ctor/Licens Ider
STATE OF FLORI
COUNTY OF Mai P j tj L
The f rgoing inst,ru ent was acknowledg d before me
this � day of _J��_ �, 21 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
Monatu ILO Otary Public -State of Florida )
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REVIEWS
FRONT
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ZONING
SUPERVISOR
PLANS
COUNTER
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
VEGETATION I
REVIEW
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