HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE IN O US B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
( �z
r.__.. 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:
Address: 7- 40-3 72// GAA- -7 , pcg-� W. SgOJl
Legal Description: i1a.,hK P v® CP PCB, r 01 �"4 6 i f- L 2 'Ldfi
Property Tax ID #: 1 'm;�;>1 ` C. 0(a - CD/? g -06 a -J Lot No. -aO
Site Plan Name: 13'2> S 2p k WA Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Haaitionai worK to oe perrormea unaer
Mechanical' Gas Tank
s permit - cnecK a
Gas Piping
Electric . _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:.3 (. oxa4
Cost of Construction: $ / '-/ v a
apply:
_ Shutters
Generator
Sq. Ft. of, First•Floor:
Utilities: Sewer _Septic
Windows/Doors
d%Roo Pitch
Building Height:
®INNER/LESSEE:
C®NTRAC� OR:
Name �T-o ''YY\
Name:
Address: �2,4os-�77- (*ovim—
Company: S .
Address: 7 40 f /SP
City: Stater
Zip Code: 34RS/ Fax:
Phone No. 3 3 z. 'e.3
E-Mail:
City: 01'�� Stater
Zip Code:.3'ql Y r Fax: 4&9-'62_1 j-
Phone No 'WL7-<52 a2-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County Licensed-0'0- 133 0C L
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not
Name:
Address:
City: State:
Zip: Phone
Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: -
Address:
City: State:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not
Name:
Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone: I
I
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 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 ekempt 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
commea�cjDg work or recording your Notice of Commend,
Si ature f Owner/ Lessee/Contractor as Agent
for Owner
Signatur of Contractor/License Holder
STATE OF FLORIDA
_
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COUNTY OF , ���
COUNTY OFC Lam`
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Th ng instr n as acknowledg,
thi 20 �
before me
by
The for ng instru nt wa a <nowledg efore me
this Vay of 20 by
ay of
(Name of person acknowledging)
(Na'me of person acknowl Bing )
0
(Signature of Public- State of Florida)
(Signature of a Public- State of Florida )
P rsonally Known OR Produced Identification
ersonally Kn OR Produced Identification
Pipe of Identification
Type of Iden�iifc2
A FF
�Pµ�p��,', ANGELA M HUFF
Co �i , Notary Public - State of r'Iorid�S
al)
p Notar Public .
�. •_ Y State 9qf�.rlor�Ia
Commissio ky ",. , ti Q; Commission # FF21 � I
_
„ ommission 234730
My Comm. Expires May 27, 2019'.
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PLANS
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014