HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC BIL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
7
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Date: 1 '6 Permit Number:
RECMMD
Planning and Development Services
Building and Code Regulation Division Permitting. Department
2300 Virginia Avenue, Fort Pierce FL 34982 County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _Z�7
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal Descriptio MOD
Property Tax ID # Lot No.
Site Plan Name: Block No.
Project Name: MAO
Setbacks Froh Back: Right Side: Left Side:
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Additional work to be performed und—er-tTis permit - check all apply:
HVAC Gas Tank Flas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: L]Sewer OSeptic Building Height:
Zip Cocle-�S&� Fax: City: Stateg/1
_L
Fill in fee simple Title Holder on next page if different E-Mail:&
from the Owner listed above) State or County Lice nse.'��:I�
If value of construction is $2500 or more, a RECORDED Notice of Commenceme ig,O'q
5'UPPLENIENLONS7FtUCT(QN L[EN W IFatMATION
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not 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:
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
bef re the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co encin work or recording our Notice of Comme cemeqt.
Lo
&t
lj&'el 9
ignature Owner/ Lessee/Contractor as Agent for Owner
' na ure f ontractor/License Holder
STATE OF FLOQ
COUNTY OF
STATE OF FLO 1►
COUNTY OF 1 I.ci�I
The, _ oing instruRient was acknowledged before me
The f r oing instrument was acknowledged before me
day A4A41
this"G°'} day of 20 by
this of 20- by
Name of perso making statement
Name of perso making statement
Personally Known 10 OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Nptary P blic- St
7
ure of otary Public- State of Florida
BEV L. HADDAD
a`4'•
Commission Ni.
:' ;:�'
, (e�}yCOMMISSION#GGO
EXPIRES: July 6,
9 m
�•" , B L. HADDAD
fission No. :81kgfl ' '�, My AISSION # GG 009363
:,,
202
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July 6, 2020
Thru Notary Public Unde
riters
s �o�e EXPIRES:
BondedThruNotaryPublicUndeWters
REVIEWS
FRONT
ZONING
SUPERVISOR
P
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
7
COMPLETED
Rev. 8/2/17