HomeMy WebLinkAboutBuilding Permit Application / I
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All APPLICABLE INFO MUST BE COM FOR APPLICATION TO BE ACCEPTED, � -
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Date: Permit Number:
•` +,. r 'i e RECEIVED SEP 2 z017
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W 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: _ M�-� l �, �r N
ti -7 so e�[,e A(/ r-f e '1 3 q S
Address:
Legal Description: T k ` i —O o c:�o CZAQ 13 13
6
Property Tax ID ®® Cp((�a� �7 0 7 Lot No. a 00
Site Plan Name: xe z" Block No. �
Project Name: t Lr >>
Setbacks Front Back: Right Side: Left Side:
P. ..�r A
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ACICl
itiona wor to a pe orme under this permit-checK all that apply:
_Mechanical- _Gas Tank _Gas Piping _Shutters ;I Windows/Doors
_Electric _Plumbing _Sprinklers =Generator CI Pitch
Total Sq. Ft of Construction: 3� t)60 Sq. Ft.of First Floor:
Cost of Construction:$ 00 Utilities: _Sewer _Septic Building Height: 5
Name Name:
Address: & ad Company: &e ,- C
City: State:_ Addres/s':
Zip Code: Fax: City:` State:
Phone No: r. Zip Code: 39`,4��� Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail r
from the Owner listed above) State or Courity;License '(=ir" s' : ��
if value of construction is 2500 or more,a RECORDED Notice of Commencement i's=required.�•..
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EL
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:
Address: - - -- - - 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recor4ing your Notice of Commencement.
Signature of Ow er/Lessee/Contractor as Ag r Owner Signature of Contr ctor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF 1 ' �'7`` - I�+� COUNTY OF
The for of g instrument was acknowledged before me The forgoing instru rat was cknowledged before me
this�y of 20 Eby this�y of 20f�by
(Name of p rson acknowledgin ) (Nam of person ackno ledging)
n
4 r 71\U ra D r&A
(Signature of Notary Public-State of Flo da) (Signature of Nota=OR
f Florida)
Personally Known �OR Produced Identification Personally Knownuced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
`►ti''Ttii KIERAN DUANE FRAMPTON
• UU.ti '44 ' KIERAN DUAIN E FRAMPTON
REVIEWS FRC •ZONiWkr'31"SLPMISCIF PLANS VEGETAT('4
COU REVIEW REVIEW • �R�f ES a
DATE �•
RECEIVED
DATE
COMPLETED IERAN D. i��
TON
ev. fi MY COMMAMblul
EXPIRES M21
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