HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date:-'(, ( ! Permit Number: 1�- �"�Q
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Building Permit Applicati
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
PERMIT TYPE:
ddress: � 7() �JRd la
2
Property Tax ID #: V O� Q 13
Site Plan Name:
Project Name:
I/
Residential
c1ha i YI A
Additional work to be performed under this permit- check all that apply:
Mechanical Gas Tank — Gas Piping _ Shutters
Electric — Plumbing — Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: ell, 5 0 C) Utilities: —Sewer _Septic
Lot No._
Block No.
Windows/Doors
Roof Pitch
Building Height:
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Name F- 13e4 14E
Name:
Address: 7' 6 la Ave
Company,
Address:
City: /?-J! �t�rC'P State: C
Zip Code: 3YOS-7 Fax:
City: State:.
Phone No. %7,,2" 618' -
Zip Code: Fax:
Phone No .
E-Mail:OIe�G'i�9$���� 1700 CCS�II
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 szsuu or more, a KLLUKUCU NUMU U1 t.V111111C11-11-1 -'y.,.....
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:
Citv:
Zip: Phone:_
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:,
BONDING COMPANY:
Name:
Address:
City -
Zip: Phone:_
Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to oo the worK aria 1MoLdI1duun dZ, I, IuIUa«u.
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 IMPROYEMENTS 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
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-- - --- - - -
i tature of Owner/ Les ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA /
STATE OF FLORIDA
COUNTY OF 5� ,1 /(Cie-
COUNTY OF
The f—oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 0.1� Jay of i 126,2[ by
this day of 20_ by
Name of person making statement.
Name of person making stateme .'
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica '
Produced L L,
Type of Identification
Produced
(Signature o No ary Public- State o Florida
(Signature of Notary Public- State of Florida )
Commission No. A
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Commission No. (Seal)
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