HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
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ALL APLICABLE INFO MUST BE COMPLETE%I;)F,i;1i�"Offfl TION TO BE ACCEPTED
Dat BY Permit Number: �o � � D
: �,1 St. facie counb]
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Building Permit Application �uL
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Plan, ing and Development Services 2018
Buil ng and Code Regulation Division LRECE
rmitting D�e a r230 T Virginia Avenue, Fort Pierce FL 34982 p to ient
Phoe: (772) 462-1553 Fax: (772) 462-1578 Commercial Rk&cielcounty, FL
PER I� IT APPLICATION FOR: To Select from dropbox, click arrow at the end of line c�
jkbi ,OSED`IMPROVEM,ENT`LOCATION
Legal
Prop rty Tax ID #: _ Q 6 (� (D Lot No. _
Site an Name: Q Block No.
Project Name: U► C. �R
Setblcks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'O'F WORK.
CONSTRUCTION INFORMATION:
iona worktoTie orme under this permit - c ec a apply:
nitHVAC
as Tank []Gas Piping Shutters ❑ Windows/Doors
Electric ftplumbmg LS rinklers Generator Roof Roof pitch
.nJ p _
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost f Construction: $ �- 0 0 Utilities.. Sewer j Septic Building Height:
OW
. ER/LESSEE ,..
CQNTRACTOR:
Nam'
Add
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Name: � f^
Company:--F2 1 UL % 1 W.City:
Addr s �.
ss: l0
Swa
Sta e:
Zip
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ode. Fax:
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City: State
Zip CEY - (� Fax: 1 �► ��J� �
Phone No.
Fill i
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E-Mail: f 0 )r � � o
State or County License: d
fee simple Title Holder on next page ( if different
the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
INEER: Not Applicable MORTGAGE COMPANY: Not Applicable
�- W C-1.1 �'7 w1!9 ... Name:.:_ .. ...
WA Address:
'-- State: City: State:
Phone %ri'Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Na e:
Adc ress:
Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone•
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi11 fy that no work or installation has commenced prior to the issuance of a permit.
St. Lu ie Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whic ! is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
stru re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In co ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accrdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f I Ilowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acces ory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAF NING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befo a the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comi miencingwork or recording our Notice of Commencement.
Sig ture of Owner/ Lessee/Contra o s Agent for Owner Signature of Contractor/License Holder
ST NE OF FLORID, STATE OF FLORID
CO NTY OF COUNTY OF-
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The Iforgoing instru nt was acknowledged efor �� a The fot oing instr nt was acknowledged before U�
this day of 20 by m this os day of 2&A by
N g
LL
o;�� r irii
j7 emu' �Ge ��a €.
(Na'' a of person acknowled g) (Name of person acknowledging V
iature o9lotaryPublic- State of Florida )
orally Knowr /OR Produced Identification
of Identification
uced
(Signature of NWry'P� State of Florida J
Personally Known OR Produced Identification
Type of Identification
Produced
Co mission No. (Seal) Commission No. (Seal)
RIVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RE EIVED
D�TE
COMPLETED