HomeMy WebLinkAboutBUILDING PERMIT APPAll APPLICABLE INFO MUST BE COMPLETED FAR APPLICATION TO BE ACCEPTED
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Permit Number.
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Building and Code Regulation Division
00 Or info Avenue, Fort Pierce FL 34982
Phone; (772) 6 -1 5 Fax: (772)462-1578
PERMIT TYPE:
Building Permit Application
Commercial
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Residential
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Address:
Property Tax ID ft: co
Site Plan arm:
Project Name:
.Po',?ETAILED-DESCRI _ JJ t +
WORKS _ fei; Y
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Lot No. C�
Block No. _
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Additional work to be
performed under this
permit
- check all
that apply:
Mechanical
!_ GasTank
Gas
Piping
.shutters Windows/Doors
Electric _Plumbing ^Sprinklers
Total Sq. Ft of Construction: �J (30 ^
Cost of Construction; $ _ 9 4 9 1 q
,Generator
q. Ft. of First Floor:
Root Pitch
Utilities: Sewe r Septic Building Height:
If value of construction is 5 0 or more, a RECORDED Notice of commencement is required.
If value of HVAC i 7 * 00 or more, a RECORDED Notice of Commencement is required'.
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j DESIGNER/ENGINEER.O.
r' Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zi P -0 Phone:
GAGE COMPANY:
MOT
Not Applicable
Name:
Address: State:
Ulty: phone:
Zip:
BONDING COMPANY:
Name:
Address:
City:
Zip. Phone:
_Not Applicable
OWNER/CONTRA OR AFFIDVIT-* Application is hereby made to obtain a permit to do the work and installation as indicate.
I certify that no work or installation has commenced prior to the issuance of a Permit.
makes representation permitwlilipe�nit holder �� ���� the Lucie County no that i� rantinauthorize the
n that � may restrict �r ��� �I� u ch
which 's in conflict with any applicable Home Owners Association rules, bylaws or and covenants t Y �
structure, please consult h r HomeOwners Association 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
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in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building ermit applications are
exempt from undergoing a full
concurr nc review: room
additions,
accessory structures swimming pools,fences
walls,
sf'gns, screen morns and
accessory uses to another
non-residential use
"WARNING T T RECORD COMMENCEMENT M RESULT IN YOU PAYING
E� ��#��E TIE �
TVVICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT DUST BE RECORDED AND
POSTED ON THE JOB SITE S'ETU"ORNE '`#r ��- T INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITHYOUR LENDER O N ATTORNEY BEFORE RED S NOTICEOFCOMMENCEMENT."
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Signature of aw erj Lessee/contractor as Agent for owner
Signature of Contractor Liven se Holder
STATE OF FLORI STATE OF FLORIDA40 �
COUNTY OF COUNTY OF
The f aing instrume t was acknowledge before me The f wing instrum nt was acknowled before me
this day of Vim_ 20�by this day of V�-��_ _ , 2� by
N q4?
or
Name of person making statement. Name of person making statement.
Person 11 Known DR Produced� ovally Knows OR Produced Identification
a y
Type of Ideriti too � MQNIOUE M. CAA40HJ Ty e of Identifi do
Produced ;w,tar Public, State of FloiidRr used � � X.00001W _
r ;.onrr1:,5LoPi# GG 269490
r- fly Comm expires Dec.14, 2022 AGs MONIQUE M. CARLON
17 Io Notary Public, State of Fbri
(Signature of No ry Public- State ofOorida j (Sign ture4�'CjNotary Public- 5t� � � �mmissron 269�9c
�j � � '� Ali
cow- e�res Dec. 14,:2i
Commission No`�� q� I i5eal] Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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