HomeMy WebLinkAboutHiggs Permit AppALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: lLffv' -1;i 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
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Property 3q l)-(gn Lot No.—
Site Plan Name: Block No.
Project Name:
Setbacks Fr
Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
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I CONSTRUCTION INFORMATION: III
❑HVAC Li Gas Tank E]GasPiping
Electric Plumbing ❑Sprinklers
Total Sq. Ft of Construction: 1L�
Cost of Construction: $
Shutters Q Windows/D000rs
Generator Q Roof / i Roof pitch
S Ft. of First Floor:
Utilities: Sewer 0Septic Building Height: !
OWNER/LESSEE:
CONTRACTOR:
Name 'I/
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Name:„�.15'
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Address:8r;6- �
Company: r
City: 124- Pl`P3'1C'e State: Fdr
Zip Code: _ Fax:
712 Phone No. `Z�4-2c'�
Address:
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City: , 4MA.4
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Zip Code: 3qq l `
Phone No. 77.0
Fax:-7
S130
State:_EL
E-Mail:_[
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: f iGkV�St
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State or County License: 13Z
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it vaKre or conscruaion is >c�uu or more, a KtwKvtu Notice of commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City: City
Zip: Phone: Zip:
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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA I
COUNTYOFCOUNTY OF
The forgoing instrument was acknowledged before me
this ].dayo/f 2021 by
JJ '—`-'litA �ex—
Name of person making statement
Personally Known _� OR Produced Identification
Type of Identification
Produced Q �%
f .Cn D�/6
(Sign}Y}Qre of Notary Public -State of Florida I
Commission No.4r� ,OP64.;O .61;3Y','Seal) JUUANNECO'W
REVIEWS I FRONT ZONING
COUNTER I REVIEW
RECEIVED
Rev.
The forgoing instrument was acknowledged before me
this a�yJof_20.:�t by Name of perso5making statement
Personally Known ✓ OR Produced Identification
Type of Identification
Produced
(Signape of Notary Public -State of Florida )
a1NtYP�& JULIANNECCLELtO
�ommissionNo. ( iwon#GG22662f
b m��for �oQPs BrdedllExplre July 22l,202wz
SUPERVISOR PLANS I VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW