HomeMy WebLinkAboutBUILDING PERMIT APPLICATION}
ALL APPLICABLE INFO MUST BE
Date: 11 J
FOR APPLICATION TO BE ACCEPTED I
Permit Number: Intl " 000Q-A
• � �-�} v �1VED
Building Perit, Application
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Planning and Development Services SCANN
Building and Code Regulation Division BY permltting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St Lucie County St. Lurie oun
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line f �.
PROPOSED IMPROVEMENT 1_0 TI'ON:
Address:
Legal Descr/ tion
Property Tax ID #:
Site Plan Name:
Project Name:
RZ
S
Lot No._
Block No.
Setbacks Front Back:11-- Right Side: Left Side: 4L4
DETAILED DESCRIPTION OF WORK:
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CONSTR ! CTION INFORMATION:
AddLitignallworktobenertormed under this permit —check all t= apply:
r-fta_ At0 Gas Tank Gas Piping _ Shutters Windows/Doors
Electric l,:umbingWrs Generator Roof Roof pitch
Total Sq. Ft' of ConstrrucS . Ft. of First looCost of Construction: $Utilities: _ Sewer _ eptic Building Height:
17 n-7n ti"I
OWNER SSEE:
CONTRACT :
Name l
ame: L�
Address: 1
Company:
Addres
��
City: State
Zip Co e:i Fax:
Ci . /�
State
Phone No.1 `.rS
Zip Cod .� Cf �? Fax:
^
E-Mail: rr
Phone No.
Fill in fee simpkAitle Holder on net age ( if different
E-Mail:
from the Owner listed above)
I
State or County Licenki UC6
ab 6Q 0
If value of construction is $2500 or mire, a RECORDED Notice of Commencement is required.
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SU±PPLEMENTAL CONSTR,UCTIONUENLA1N INFORMATION'
DESIGNER/ENGINEER: _ Not A
Name: Al) �!Y �DP ino i G
milli
All/l,T�i -
FEE SIMPLE TITLE OLDER: _ Not Applicable
Name:
Address: El
City:
Zip: Phone:
-
�z 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 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
improv Ir property. A Notice of Commencen3entirmst be r corded and posted on the jobsite
ci
be a the first inspec ill you intend to obtain fin ng, consul witpi lender or an attorney before
commencing work QZ r c rding your Notice of Com encement. �iJJ
Signal rL-ee of Owner/ Lessee/Contractor a
of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OFJCOUNTY OFF s
The forgoing instrument was acknowledged before me
thisc� day of i 2l by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
Notary Public - State of Florida
My Comm. Expires Dec 20, 2018
REVIEW FR(
CO U
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
The forgoing instrument was acknowledged before me
this 'a- day of Ill 2l by
Name of person making statement
Personally Known OR Produced Identification
Type of identification
Produced
(Signature of Notary Public -State of'F4orida )
Commission No•-. — T _ _ (Seal
VPU"4
LASHAHNA INGRAM
Notary Public -State of Florid
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Expires Dec
'-`Fl IRTLE 17
0, 2018
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