HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number: 1$ O
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Building Permit ApplicaPlannin and Development Services
Building nd Code Regulation Division
2300 V'I Iginia Avenue, Fort Pierce FL 34982
Phone: i(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
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Legal De
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PERM
TAPPLICATION FOR: t C-l�l.t-S g� --S% SCANNED
PROP
SED INPROVEMr ,ENT LOCA IC)N.
(20(;
ription: _
Propert''Tax ID #: 't[Q
Site Pla Name:
Project ame:
Setbac ! Front Back:
Tota I
Cost
u .k-
11 1 Ai i-r
Right Side: Left Side:
'ORK.
Lot No.
Block No.
al work to be pertormeci under this permit- check all that apply:
chanical _ Gas Tank —Gas Piping _ Shutters Joindows/Doors
ctric �Olumbing _ Sprinklers _ Generator _ Roof Pitch
Ft of Construction:
instruction: $ S zoo -00
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Nam E✓ I--1-�S�R-u Jl Name:
Addrt'd
s �Uy I YL� (L�(I �a? Company:City: !� State: Address: ;;;,.'Zip e: !3�G�' Fax: :.City:. - _ - State:
Phonii No. Zip Code: Fax:
E-Mail: - CST .���T Phone No
I
Fill i ifee simple Title Holder on next page (if different E-Mail
from i, he Owner listed above) State•or County License
If valu4of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTG E CO ANY: Not ' licable
_ .
Name: Name: i�S 6� r � r T v�-F .�,- rzri
Address: Address
City: State: City: 194/4- ?AKc Cr A!, State: (e,7—
Zip: Phone Zip: S' 6r Phone: / f(Do '� ebo 2
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:_
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_Not Applicable
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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin,Kwork or rZcordina vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instru ent w s acknowledge efore me
this day of 20M by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida) /
Personally Known OR Produced Identification V
Type of Identification
Produced 1:—L
,�,�,yp;,, KAREN S. NIELSEN
Commission No. .o �': State (f$TA6)•ida-Notary Publl
.JJf;(.JLJ*s commission # GG 207484
3;�,�,-__. 1c My commission Expires
The forgoing instrument was acknowledged before me
this day of. . 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. (Seal)
11 ,n1
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NING
SUPERVISOR
REVIEWS
FRO
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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