HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP
Date:
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
PermitNumber: kkq-01�o
ISCANNO 'RECEIV�D
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U1 PeRmit Application
B Ildi 18
Planning and Development Services LAPR 2 5 2018
Building and Code Regulation Division ST. Lu . cie CounLty,Permittina
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
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Address: /0
Legal Description:
Property Tax ID #: m2y-'5-0)
Site Plan Name:
Project Name:
Back:
Setbacks Front-
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Lot No.
Block No.
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Additional work to be
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nertormed
Gas Tank.
unci rtnis permit— cneCK all
[]Gas Piping
appiy:
Shutters
Windows/Doors
Electric
Plumbing
OSprinklers
FV7
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Generator
Roof
Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ Utilities:'n Sewer OSeptic Building Height:
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Name D&V 10 A. A], 6-7 L&
Address: JM
Name: 10A VA) E
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Company: alm&;eraAML
City: PL)P_T S-T LU&&r- State:
Zip Code: 9;?17 Fax:
PhoneNo. qr7C.6
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E-Mail:
Fill in fee simple Title Holder on ne�t page (if different
Address: /6-0/ 91A)A 11-MOWE 9 7-
City: ROO- (SIT MOE state:_/�
Zip Code: -?q WS F a x: Vo?- 79S_-
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Phone No. 1��_ 7S,5 ,
E-Mail: kl) 1171Q - CC,5'6V, /P CW /. C677�
State or County License:
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from the Owner listed above)
If value of construction is 52500 or mote, a RECORDED Notice ot Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:—
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Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: AIpplication is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has co mmenced prior to the issuance of a permit.
I
St. Lucie County makes no representation ihat is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Horne 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 requi ested 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.
I
The following building permit applications a' re exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fend I es, walls, signs, screen rooms and accessory uses to another non-residential use
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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 yourl' Notice of Commencement.
�i7Xnature o Fvner/ Lessee/Contractor ag,,Agent for Owner
li-gnatu-re Holder
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STATE OF FLORIDA
OF lUd
.1ontractor/License
STATE F F nRIDA
COUNTY OF 105
COUNTY
The r oing inst t owledge')
Zty of ru as ackn �efore me
thi% ZL 20JZ, by
t t acknowledged before me
Th f ins ru W&K
thWmy of 20JJ by
Name of perso making stateme.9 I t
Name of per'g making statement
Personally Knowi OR Produced Identification
Personally Knc --cluced Identification
Type of Identification
Type of Identification
Produced-
Produced
(Signature of Nota(YiPublic- State of Florida
(Signatu're of Notary Pu 01- State of Florida
Commission No. r—Q,?J3 3 (Seal)
Commission No. rfqf1331 (Seal)
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17