HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,
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ALL APPLICABLE INFO MUST BE COMPLETED
Date:
Buil
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-151
DR APPLICATION TO BE ACCEPTED �ay
SCANNED Permit Number:
St Lude CaUfltV RECEIVED
ng Permit Application MAR 2 0 ��Olg.
ST. Lucie County, Permitting
Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #: 1 Ilu 1 WV
Site Plan Name:
Project Name:
Setbacks Front Back:
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1
5l 01/7 Oa
1
1
Right Side:
Left Side:
Lot No.
Block No.
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d�c,K n sl211 new Go (opt rn5_ 1_ fvrrn _lot f���*-r r.
Aaaitlonal worKto De
❑HVAC
erTormea
E]
Gas Tank
Unaertnls permit—cnecK all
❑Gas Piping
apply:
Shutters
❑ Windows/Doors
❑
Electric
0
Plumbing
❑Sprinklers
_
❑
Generator
❑
Roof
Roof
pitch
Total Sq. Ft of Construction:: 1 Sq. Ft. of First Floor:
Cost of Construction: $ _` (��3 .OD Utilities: Sewer ❑Septic Building Height:
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Name 7YOMb
Name IeUSS D
Address: 6709 r dcom iho% Rd
Company: Fomdv 6/S /n
City: F•% Re -pre- State: FL
Address:7 9'" MGaC1edn
Zip Code: 3LI451 i� Fax:
/(f'L�1S
City: PY cS* Lucre State:
Phone No. 172 205- 0335
Zip Code: Jy0 A3 Fax:
Phone No:_77A 8'IR- t��So2
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License: cFJ`
It value of construction is 57500 or more, a RECORDED Notice of Commencement is required.
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UPPLEtVIENTAL �C}STRU1-Itl 1�1i IiR(11AT1CN.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
I
Name:
Address:
Address:
City:
State!
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
I
Address:
City:
City:
I
Zip: Phone:
Zip: Phone: i
I
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work andinstallation 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 Hermit, 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 exe; pt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory use 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
commencing work or recording vour Notice of Commencement.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
Si- Ui r
STATE OF FLORIDl %G
COUNTY OF
COUNTY OF I-e,
The fing instru ent�J !as acknowledged (fore me
The f going instrum nt wa acknowledg d _before me
�
thisday of ma .1 I 20 6y
this day of r 20E by
Fran.y- ?usso
FraY-LK 9"ss0
Name of personp aking statement I /
Name of person making statement /
Personally Known `� OR Produced Identification ✓
Personally Known ✓OR Produced Identificatien
Type of Identification
R.,
Type of [den . 'cation
Produced
Produced
d ao�x& .
fycw
(Signature of Notary Publi - State of Florida;)
(Signature of Notary Publi - State of Florida )
i
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
i
ZONING.:
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Rev. 8/2/17 NICHOLE AP „��,,,, NICHOLE-APONTE
`=01PaY Pu��n� State of Florida -'Notary Public `�1pPV PV61i
Commission #; FF 963031 =.io ��; State of Florida - Notary Public
Commission # FF 963031
My Comm Expires 06 04-2020 ;,yam PQ My Comm. Expires 05-04-2020
Bonded Through -w, �i,'OF F����� Bonded Through