HomeMy WebLinkAboutBuilding Permit Application (VOID)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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•3®� c; Permit, umber:
Date: .
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Building Permit pp
ica
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Planning and DevelopmentServices y
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential _—
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _�
Address:
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Block No.
Additional work to be performed under this permit— check all that apply:
Shutters ••'Windows/Doors,
_Mechanical _ Gas Tank _ Gas Piping — —
Roof Pitch
_ Electric _Plumbing _Sprinklers _ Generator —
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: -Sewer _Septic Building Height:
Name I fi
Address: /P��3I .� �n���� iU�`� f�
City: Stater
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Ho der on next page ( if different
from the Owner listed above)
Name: 41's&<
Company:
Address:
City -
State:
Zip Code: Fax:
Phone No
•E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a,,KCORDED Notice of Commencement is required.
DESIGNE
N'ame:_
Address:
City: _
Zip:
NEER:
Phone
11
Not Applicable
State
FEE SIMPLE TITLE HOLDER: rl ;_.Not•Ap,plicab.le
Name:
Address:
City:_
Zip:
Phone:
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 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, l 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 IMPROVEMENT'S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
.�.. _evf%w%r nc vnonaiur- Yna iv mnlrirF nF 1't MMENCEMENT."
"I I tWUVK a rMUCK 'UK AM tan a US%Iw _
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Sign at e of Owner/ Lessee/Co acto4ra;s!Ag t for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF L.IA�L-
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of1294re2egf'1^ , 20-746y
this _, day of , 20_ by
Name of person making statement.
Name of person making statement.
/
y
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature of Notary Pu ic- State of Florida)
cc. a M •a
ignature of Notary Public- State of Florida )
O>,aoC
Commission No. (Seal)
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mmission No. (Seal)
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REVIEWS
FRONT
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VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REV
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
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COMPLETED
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