HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: p?� 0�) - Ul -)"
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982
Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMITTYPE: s�
Address: )9SO I3R00ecSrn%-rr.4 Mom.,
Lot No.
Property Tax ID #: ,I�"E�v� %
Block No.
Site Plan Name:
Project Name:
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Additional work to be performed under this permit- check all that apply:
/Mechanical _ Gas Tank — Gas Piping _ Shutters ✓Windows/Doors
Electric -"Plumbing _Sprinklers _Generator Roof /I? Pitch
Total Sq. Ft of Construction: \6 •00 Sq. Ft. of First Floor: 116, 00
Cost of Construction: $ An n Oa Utilities: _Sewer ✓ Septic Building Height:
Name QbpoLroy
Address:-goA, Osa�nnw 92
city: FAT -Pm'z cc-- State:
Zip Code: -Q-,�'d 2 Fax:
Phone No. T7'12 - 240 S6 4 � n
E-Mail: � nt — i-� o�kc-::, s�2uc-ctcok, l 9 Met
Fill in fee simple Title Holder on next page ( fi dFlferent
from the owner listed above)
Name:
T
Company: BW.• D4SJ,6
Address: 2,i�S 2- 46tt4-
City: �+
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Zip Code: Fax:
4one No , E 6 1 6 Br __ 3, 1
E-Mail_6o, 6IV) Jsr�po.Cgrn .
State or'County License C6C- lsj /6ol fit .
If value of construction is $2500 or more, a KELUKUtU INOUCe Of l Ullunen�cn�o�� c.q .••
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
Citv:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City
Zip: Phone:_
- Not Applicable
State:
— Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
Citv.
Zip: Phone:.
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 structure. Please c with
withpyoiurHlome Owners Asome sociation
ation a ndrreviewyyour dws eed or any and restrictions nts that wh which may arestrict or . prohibit such
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 F!RST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOfin7eNG YOUR NOTICE OF COMMENCEMENT."
"
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORI
COUNTY OF L,vGJ{
The for oing instrument was acknowledged before me
this., day of 20_Z( by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- StaVof Florida)
Commission No. (Sea
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FRONT
COUNTER
ZONING
REVIEW
Rvffi
igeREVIEWS
2 JV TE�
DATE
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RECEIVED
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DATE
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COMPLETED
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Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for instrument was acknowledged before me
this day of , 20 -
-W!17— 4e by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of �NotaryPublic- S�eof Florida }
Commission No
(Seal)
R I REVIEW I VREVIEW
ON I SEREV EWLE
PLANS
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