HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIpli
All APPLICABLE INFO MUST BE COMPLE4'ru FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Appli tioRJ� 2 4 2018
Planning a, d Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 VirghIlia Avenue, Fort Pierce FL-34982
Phone: (4,721462-1553 Fax: (7721462-1578 Commercial Residential X
PERMI APPLICATION FOR:.
P OPOSED INPRC?�lE ENT LD ATItN,;WIWI
Address:
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Legal Desc
i
�ption:
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Property T4Ix ID #: 3 0 — J510 — 010 11— V061—S Lot No.
Site Plan N me: Block No.
Proiect Na l e:
Setbacks i Front Back: Right Side: Left Side:
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4f Qr L/
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COTMecIlinical
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IN'F® MAT ON.
_ Elec
Total Sq. F�
to a performed under t is permit — c ec a that apply:
_ Gas Tank _ Gas Piping _ Shutters_
is _ Plumbing _ Sprinklers _ Generator
of Construction: Q 5O0 5"r Sq. Ft. of First Floor:
Windows/Doors
X Roof 3 i Pitch
..von — ..., 11", ua.�lvll. Y — u I-- _ _V .' vu n...—.V, I --- V".1.
OWNER/�E�S�SE
CONTR �R:
Name
Address:
City:
Zip Code�l
Phone N
E-Mail:
Fill in fee�lsimpie
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Name:
--Company: ` i!
State
,JCI 5D_ Fax:
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Address:.,,
City: State:
Zi p Code: Fax:
Phone No
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Title Holder on next page ( if different
O ner fisted a ove)
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E-Mail
State or County Licensetip,
If value of c�nstruction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT L C � NSTRUCTIpN l.:I!EN INF4'R ATIQ
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
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. I
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject Structure
is
which 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
commencing work or recording our NQ6ce of Commencement.
Sighature of Owner/ Lessee/Contractor as.Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Q, COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this aN day of 'Sul V 20� by this day of 20_ by
of
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identificationp
Type of Ide 'fication Type of Identification
Produced 1. Produced
I.
(Signature of Notary Pub ' - �MpR1EGNENS (Signature of Notary Public- State of Florida )
"ySt y, Idy MMISSION # GG 022023
Commission No. $ ;. =:December"'20 (Seal)
te� Commission No.
_,,�TfuuNotaryPubllcUnde
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
,
DATE
COMPLETED
�_e_v_.8/2/17