HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJ
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: To Select from dropbox, click arrow at the end of line
Address:, 21�WWHFJ NU I
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Lot No.
Site Plan Name: / // Block No.
Project Name: @.a
Setbacks Front Back: Right Side: Left Side:
1]HVAC
Tank
r ...,.. ....
Gas Piping
�rN,r.
Shutters
_Gas
11
Electric
Plumbing
[-]
Sprinklers
OGenerator
Total Sq. Ft of Construction: ``,,���
Cost of Construction: $ I 'lCD - W
S Ft. of First Floor: _
Utilities:Sewer Septic
Roof Roof pitch
Building Height:
UUI/NEft/LESS: t9 �,�` x
CON I-RACTOR'
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Name _l X_°
Name:
Company:
Ad • l b�
City: State
Address:
Zip Code:,S4 t���,ii�� (-) Fax: — I
City: Stannt��e��
Phone
Zip Code: Z Fax-
Phone N
E-Mail.,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_
St4e or County License:��(��
It value of construction is 52500 or more, a RECORDED Notice of Cort;ncement is required. Cat 1
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
_ Not Applicable
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
BONDING COMPANY:
Name:
Not Applicable
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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work or recording our Notice of cemeyM
Si ature of wner/ Lessee/Contractor as Agent for Owner
Signature 77ontractor/License Holder
STATE O O
STATE OF FLOR
COUNTY OF t�
COUNTY OF �;
The fol g,Qing instrAkment was acknowledged before me
The fo ing ins _ ment was acknowledged before me
May
this- 4day of 20a by
this of 20t� by
�
a� L
RName
,
o rs making statement
Name of p on making statement
Personally Known V OR Produced Identification
Personally Known / OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
iWC4'
�LA'
(Signature of Notary
-
(Signature of Notary Public-
State-ofFlorida
;� Sr�C :;q•••,, B L. ADDAD
MY COM ��N # GG 009363
EV L. HADDAD
_°'' :"•= OIIbN#GG009363
MY C
Commission No.
Commission No.
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• EXPIRES: July 6, 2020
" : :c r EXPIRES: July 6, 2020
"'� 4PiPk�P.• B=W Thru Notary Public Underwriters
'%; ;oc e4Q ••`Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17