HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP IICABLE INFO MUST BE COMPLETED FOR APPLIdATION TO BE ACCEPTED /903-,l
ISCANNED Permit Number: A2.
Date: BY
Building Permit Application �
Planningand Development Services l
Buildin and Code Regulation Division
2300 Vi lainia Avenue, Fort Pierce FL 34982
Phone :,(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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PERM T APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROP SED IMPROVEMENT LOCATIO
Address
ANdal Del, cription:or, w _ ,
S
PropertTax ID #: % —� Lot No.
Site Pla Name: Block No.
Project h ame:
Setbacl, s Front Back: l Right Side: L3- Left Side:
DETA'I � ED DESCRIPTION OF WORK:
a2
CONS RUCTION INFORMATION:
Additic nal work to fl
orme un er t is permit —c ec a app y:
AC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
A 7-
ectr El Plumbing � ❑ Sprinklers ❑ Generator Roof Roof pitch
Total S # bbffY.Qtruvion: S . Ft. of Firs Floor:
Cost of , Utilities Sewer ptic Building Height:
OWN'R/QaM
CONTRACTOR:
Name
Name:
5: ZL911 5/'(] kJ9?V
Addre
Company:
L statVI
City:
Address:
Zip Co
e: Fax: --
City: State:
Phone
4
o. —0445_�
Zip Code: Fax:
E-Mai
Phone No.
be simple Title Holder on next page ( if different
Fill in I
E-Mail:
from It
e ner listed above)
State or County License:60
If valuo!of construction Is $2100 or more, a RECORDED Notice of Commencement is required.
UP
MENTAL CONSTRUCTION LIEN LA11� INFORMATION
DESIG
Name:
Add r
Cit
Zip
NGINE R: _
i -i�
Not ApplicablO
MORTGAG C
Name: /
Address:
City.
Zip:
PANY:
Phone:
_ N A plicable
State:
State:
hone
FEE SI
Name:
Address
City:
Zip:
PLE TI HOLDER: _
---
t Applicable
BONDING CO
Name:
Address:
City:
PAN
Not Applicable
Phone:
Zip: hone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify th no work or installation has commenced prior to the issuance of a permit.
St. Lucie Co' myy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in 0nflict 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 consider Jon of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordan I with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follow[ Ig building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory s uctures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNIN TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improve gents to your property. A Notice of Commencement must be recorded and posted on the jobsite
before th first inspection. If you intend to obtain financing, consult with lender or an attorney before
commen n work or recording your Notice of Commencement.
Signature
STATE (
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Owner/ Lessee/Contractor as Agent for Owner
FLORIDA 11
)F
The f goi g instent was acknowledged before me
this d y of r gIkZ 26a by
N me of person making statement
N
y �nown OR Produced Identification
t' ' n
e f No Public- State o Florida )
Commissio No. ,�����„ (S'elal,),HNA INGRAM
Notary Public -State of Florida
. • ; • My Comm. Expires Dec 20, 2018
__ u �[ 4771)dQ
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
of F
throuc
h Ilational Notary Assn
REVIEWS
FRO """'
SUPERVISOR
' PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUA T R
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
9
COMPLET
D
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'Rev. S/2/17
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