HomeMy WebLinkAboutBuilding Permit Applicationi
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ! to • �l J ��
® Building Permit Application z:ii''
Planning and Development Services Oct Z
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PAR �011
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 811. u�;�G
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: o� % C %� b _ (2 I r d F— l
Legal Description: 4 v 0.0, l `
Property Tax ID #: 3 yam �� p2 — �jry — OHO f'i 4 Lot No.
Site Plan Name: 4 0 ok 0 lu Block No.
Project Name: Fc'e CQ -!�4 to Z
Setbacks Front Back: Right Side: Left Side:
Re lgce 1f X �� Ck,4,c- dID
Additional work to b
jeeffo—rmed under tis permit —check all apply:
E1HVAC L_J Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: J G f S . Ft. of First Floor:
I
Cost of Construction: $ 4t) Q Utilities. _ Sewer O Septic Building Height:
OWNER%LESSEE F k t>
=CONTRACTOR r
Name �cr
Name: V
Company:
Address: �c�.g i� o v�. c ti h. C
City: C State: j
Address:
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City: s
State:
Zip Code: 3 g Fax:
Zip Code: 3 q 7 c'�,
Fax: qo - 0s 02 cA
Phone No.
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E-Mail:
Phone No. o
Fill in fee simple Title Holder on next page ( if different
E-Mail: e- Z (a1
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from the Owner listed above)
State or County License: 0—
D 0� (0 .6�
if value of Construction is $z5uu or more, a KtLUKUtU IMOXICe Or wrnrnCnI.c111ena 13 Iayun
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S,UPPLEMNTAI_ CONSTRUCTION LfEN LAW IN,FORNIATION
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DESIGNER/ NG�NEER• No Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name: o c
Name:
Address:
Address: va eS qe
City: f 12'sc Stater
Zip: Phone 7 ,
City:
Zip: Phone:
State:
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 postedpn the jobsite
before the first inspection. ou intend to obtain financing, consul th lender or an at rn y before
' commencork or rec din our Notice of Commencement.
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Signature o wner/ Lesset76r as Agent for Owner
Signature of Contractor/License olde
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S� ��
COUNTYOF e.
The forgoing instrument was acknowledged before me
� 'Uc \-e � 20 (? by
The forgoing instrume@nt was acknowledged before me
this May of 0 G, 20VI by
this day of
Name of person making statement
Name of person making statement
Personally Known OR Produced Identificatio
Personally Known OR Produced Identificatio
Type of I entification
Produced �`►esC'S Li C-�(���
�"°:'•
+.:
T YP
Type
Produced��
(Sign Notary Publ' -State of Florida)
��
igna r otary Publi State of Florida)
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Commission No. (Seal)
T
i s s i o n No . 2A36t (Seal)
C
REVIEWS
FRONT
ZONING
SUPERVISOLVS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE1/I
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17