HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J' ! —/ Co Permit Number: i l (p®3 -03 7
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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:
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-Address: - z 6 111J r o a LO � �
Legal Description:
Property Tax ID#: �"I �� '� � 'L'�� Lot No.
Site Plan Name: Block No.;
Project Name:
Setbacks Front Back: Right Side: Left Side: !
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�Additional work to be pertormecl un�er t is permit—check alt at appy: �
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_Mechanical _Gas Tank _Gas Piping _Shutters ,I', —.Windows/Doors
_Electric _Plumbing_ Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ (9 '60 Utilities: —Sewer _Septic Building Height:
OINNERLESL=� �� 4 � SCC► TRAGT4R � Y
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Name r-- re- Name:
Address: /U itf 14 Company:;
City:J r f ct lc� State: � Addre'ss:
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Zip Code: 3�/c( q G Fax: City: State:
Phone No. 17 a J3 2�a- -�S�6 Zip Code: "i Fax:
E-Mail:--. c�,nrK, Z( age'QA,--PSl. ti Phone No
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.
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�5UPPEEMENT, LCO'NSTRI�CT(0�L �IV LA�W�IN�ORMATIO� � ��
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
.Name: . __ _ _.. _ . . _ arrre:--_._,. ----
Address: Address:
City: State: City: State:
Zip: Phone 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 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
commencing work or recording our Notice of Commencement.
Sig re of 6w_nerrLes's&/0Wactor as Agent for Owner Signature of Contractor/License Holder
S TE OF FLORIDA STATE OF FLORIDA
COUNTY OF , COUNTY OF
The f rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thio_day of]D2p n 11h ,20% by this day of ,20_ by
(Name of person acknowledgM ) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced FCL_ Q% '7R04Q. y�SrA,S4 3qi 1• U Produced
Commission No. .+++�Pia, (SeaIQASHAHNA INGRAM C mission No. (Seal)
2� „`�•; Notary Public-State of Florl a
' • M Comm.Expires Dec 20,2 18
:;� Co mission# FF 177249
REVIEWS FRONT %yid NGonded h6W P6RV49QRy ssn NS VEGETATION SEATURTLE MANGROVE
COUNTE "yR`V 1 -`'` IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.