HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.6.
All APPLICABLE INFO MUST BE COMPLEI .i .:OR APPLICATION TO BE ACCEPTED r�
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Permit Number: (a! I �� ` UalzI
Date:
_x m. _M,........ 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: Y `� me � �' � C
PRt3P�JSEQ
NPROVMENT:LQCATIaN�°
Address: r7 3 O q -<� ./-g ?4w z0` Fy- Aill'-G/', )52; .?. 9 9 a l
Legal Description: oi� , I P edGfi z
Property Tax ID #: °2 �! o� Ool 0,0 3 � 000 0;
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: _
Left Side:
Lot No._
Block No.
aitionai worK to oe pertormea unaer tnis permit- cnecK an tnat apply:
_Mechanical _ Gas Tank, _ Gas Piping —Shutters, Windows/Doors
—.Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / D 6 0 e _ Utilities: —Sewer _Septic Building Height:
Name 1/ me 1 " - -
Address: 3- S7-
City: Stater
Zip Code: 3 y9 (fl Fax:
Phone No. '7 53 0 -• 0 Crr o�f
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: H ymd.Ja, K. U, L t,4- J 04b
Company: �%11 N �v� �i �s7%tiLCi ew}+rC
Address: a4-6 F d ✓P�.�� >���(�
City: Vie. r c State:
IT -
Zip Code: 9 4 f L- Fax:
Phone No
E-Mail I^ab 10/1r,,i o/Gas t
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
n7,1
SUPRI.EMENIAL CONSTR CTO�NIIEN LAW INFC}R/fA11Q,
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_�,* w,: N4 •'''.. ...ba ;bF, if °x, •. ,.a �•.. ,,_.
DESIGNER/ENGINEER: _ Not.Applicable MORTGAGE COMPANY: Nof 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: I Address:
City: I' City:
Zip: Phone: 1 Zip: Phone:
I
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 As,'sociation 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,lsigns, 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
commenSjqg work or recording our Notice) of Commencement.
Signatu Owner/ Lessee/ ontractor for
of as Agent Owner
Si atu of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDq
COUNTY OF 154- Gu,r i e—
COUNTY OF S J
I
The forgoing instrumenp was acknowledged before me
The forgoing instru t was acknowledged before me
this [� day of ' 20� by
this day of 20_0 by
Y
(Name of pers n acknowledging) j
(Name of person cknowledging )
1
igna ure of Notary Public- Sitate of Florida)
(S1 ture of Notary Public- S13te of Florida )
Personally Known OR Produced Identification—
Personally Known OR Produced Identification
Type of Identification �L
Type of Identification
Produced
�,uuna,
Commission No. ,, caa�nJ'' (�I41gHNA INGRAM
Produced
A HA1% I G AM
Commission No ?'� a Notary Public {Seallt Florida
_=��: Nofaly u lic 'State of Florida ..
My Comm. Expires Dec
YNot
:N x• "�; mm. Expires Dec 20, ?-01R.
�o;FOFF,oa;°�' Commission
20, 2016,
FF 17724o
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1
Rev. 7/2014
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