HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: OUO �` �� Permit Number: I v
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Building Permit Application APR b 5 2011
Planning and Development Services Permitting D2;)artment
Building and Code Regulation Division SL. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial . Residential
PERMIT TYPE:
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Property Tax ID #: �,rC. .�� �� In- Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed; under this permit-check all that apply:
_Mechanical Gas Tank Gas Piping _Shutters indows/Doors.
_Electric _Plumbing Sprinklers _Generator _Roof . �.� Pitch
Total Sq. Ft of Construction: 7 S'qu Sq. Ft. of First Floor: 0
Cost of Construction: Utilities: —Sewer _Septic Building Height: k _
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Name v I Name:
Address: �d� �G//D l!'i�S GJ-VG/ca J4 VICompany: L
City: / Statem-F I Address: cf�D ui
Zip Code: Fax: City: -l1h 7-!�/� State: .��
Phone No.� �/ Zip Code: /S Fax:
E-Mail: Phone No 7, O e�
Fill in fee simple Title Holder on next Page( if different E-Mail
from the Owner listed above) State or County LicenseG
If value of construction is$2500 or more,a RECORDED Notice of Commencement is 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:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Ad d ress: 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENQER70R AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CO ME4NCEMENT."
Signatu e r e/Contractor as Agent for Owner Signature of c nse Holder
STATE OFF RID STATE C FLO D •
COUNTY COUNTY OF
The forgoing instr ent wad acknowledged before me The for.��.i!ng instr ment was acknowledged before me
this day o 20a by this ,"]iday _, 2ana by
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Name of person maki g statement. Name of person maki g tatement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of o - .=P�biiref- jJ ila]] 1 (Signature of N t Public State of Florda
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SPPvrca`, AUOREY L 13�
Commission N MYCOMN41S51� rG 4� ``
F i!';fi ,��ZU.- 1,, Commiss SP°Y �nPryR.FiUI'PH ![Seal) r}
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