HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED
Date: 1T Permit Number: kl a� —dllia
4111111111111
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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: a_ q• fi3
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PROPOSED IINPROUEMEN_T LOCATI'� N: _
Address: 67
Legal Description:
Property Tax ID#: CZ� " Q l5 Lot No.
Site Plan Name: " rr / 4� Block No.
Project Name: / row
Setbacks Front Back:' Right-Side: Left Side:
DETAILED 10 O-F WORK:
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C®N4STRUCTION 11INFORM TI0'N:
Additional work to be pertormed under this permit-check all that apply:
_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:$ Utilities: _Sewer _Septic Building Height:
FOR 'ER/L@S�SEE: C®NTRACTOR:
Name / Name:
Address: 3�a /., Company: rJ#"'o
City: A f I� State:_Wl Add re
Zip Code: U Fax: City: 4 State:
Phone No. Zip Code: Fax:
E-Mail: Phone No o7- L
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S*UPPLEIUIENTAL CONSTRUCTION LIEN LA11U INF®RIUI'�►TION ;emu
DESIGN ER/E NEER; j Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone o` Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit toAo 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
comnj&icrPg workimecoo8ing your Notice of Commencem
Sig ture of Ow er Less a/Co actor as Agent for Owner ignature C ntract r/Li rise Holder
STATE OF FL A STATE O ORID ,
COUNTY OF S �. �-V-e�� COUNTY OF �
The forgoing instrument was acknowledged before me The forgoing instr ment was acknowledged before me
this 1 day of Q �? f�1 20� by this 1 day of C! 20_4 by
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(Name of person acknowle Bing) (Name of pers n acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary P lic-State of Florida)
�F GNENS
Personally Known ucul@ �� Personally Known OR Produced Identification
Type of Identification ;c: :P.�o:;; MYCOMMISSI roc 2u2o Type of Identificati
Produced * FXP�RSN ryPu����mae^" ters Produced NNAMARIEGNEN5
MY COMMISSION#GG U22U23
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Commission No. Seal) Commission- �: � :DecemberlJNA1
Bone r ota ry Public U Idrs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R-e-v-. 7/2014