HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �/ Permit Number_
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Building Permit Applicatio REC EIVED
Planning and Development Services
13 2017
Building and Code Regulation Division NOV
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial �Tm � rtment.
PERMIT APPLICATION FOR: To Select from dropbox, crick arrow at a A.o�iii�
PROPOSED IMPROV.EMENT'LO-CATION:.
Address: 4 90-2 Pm w-e . ) ei,✓,e
Legal Description:
Property Tax ID #: 133 1 �d °� Go 14 — �d� — ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILI D'DE$CRIPTION-OF WORK:
�2y 'ZTaw t< �w{�
CONSTRUCTION INF0RMATIQN .
p mit—c ec a app y:0HVAC oGas aWindows/Doors
rtiona wor to e orme underPSprinklers
Tank Gas Piping Shutters
Electric �Plumbing O Generator Roof Roof pitch
Total Sq. Ft of Construction:: S Ft. of First) Floor:
��� 4 ]
Cost of Construction: $ r7. Utilities- Sewer L Septic Building Height:
OWNER/LESSEE: :
-ONTR•ACTOR:
Name C-f AtO M P1 C(ire P.
Name: n7r,,C f D a
Address:_ Cjl0 A", w MC'2C-,ghp 7
Company: ['.0+2`14 GAT C
City; � L . State: �
PS
Address:
Zip Code: Fax:
City: State-�<
Phone No. Sr-1 319 .2 R—a
Zip Code: Fax:
E-Mail:
Phone No. 6-2jq 94l
Fill in fee simple Title Holder on next page ( if different
E-Mail: ez,e yoC o
from the Owner listed above)
State or County License:
a0 1 5
It value oT construction is $2500 or more, a RECORDED Notice of
Commencement is required.
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SUPPLEJtIIENTALCE0 4STRUCTtf l #E 11y41N:INFt3RllrlA 1QN:.; " :. -
DESIGNER%ENGINEER: NotAAplicable MORTGAGE COMPANY: — NotAppliCable . '.
Name: Name:
Address: Address: I
Cry: State: ;
Zp- _ Phone Z City: i Phone: State:
FEE SIMPLE TITLE HOLDER., , Not Applicable BONDING COMPANY: iNot Applicable
Name -
Name:
Address: Address: I
City: C fi,.
Zip: Phone: Zip.•• I 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 Count
oun makes no representation that is granting a permit will authorize the ennit holder to build the subject structure
which is in con�ct with any applicable Home Owners Association rules, bylaws or an6venants that may restrict or prohibit such
structure Please consult.wrth your Home Owners Association and review your deed r 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 CouhtIyAmendments.
The following building permit applications are exemptfrom undergoinga full concurr) ncy review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accesso 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 wit nder or an attorney before
commencing i#orkO recording your Notice of Commencement_ r
as Agent for Owner
STATE OF FLORIDA STATE OF FI.Ot-DA
COUNTY OF COUNTY OF jZ.
The foy�Qing instrument was acknowledged before me The forgoing instnYment was acknowledged before me
this _Ci"days ,�I1tZ 20��by this.�dayof I�dill 20�by
&a l c_ 1 �orJ-f4C 1 f P9bU
Name of person making statement Name jofersson making statement
Personally Known r011 Produced identification Personally Kno---OR Produced Identificatlo�,Type of I entification Type of Identilil
Produc /Ir 2 7} 1 Produced i 2 (I V
REVIEWS
CONIPLEiI
Rev. 8%2f 17.
(Signature of
My Comm. Expires May 1 - g o�"��n, SHER Y TOOMEY
FF 12 Sd'� Commission No. .°<�"��•,, ��}}r
otaryPubli seme of Florida
rJ
BandedTlumyhNabmal1k1WyAssn. I My Comm. Expires May 19, 2018
%_' Commission # FF 124535
FRONT I ZONING I SUPERVISOR I' PLANS
COUNTER REVIEW REVIEW I REVIEW
REVIEW I REVIEW
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