HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3\ 1T� Permit Number:
— — RECEIV�p
• JAN 0 3 2019
- ---I Building Permit Applica SiLGcleoougt PEPn11FzII19
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 \
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �J(
PERMIT APPLICATION FOR: BY
Address: WA
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Legal Description: hGZiY° t�)Aa dart -ar/T'-e 61vilt 47- A87 MO-4 /3LO A J QW-
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Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
-D00-
Right Side: _
Left Side:
Lot No.
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof 3; /7 Pitch
Total Sq. Ft of Construction: ilwp
Cost of Construction: $ d
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Building Height:
OWNER/LLSSEEs
CONTRACTOR:
Nam ' YYe 7° lL D
Name: -, : ,, :,:;
}i
Addr ss: _
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Company: ' e/
City: ` uC2 "`' °' State:_
Zip Code: Fax:
Phone No.
Addre`MID DA
City: V State:
,p
Zip Code: Fax: %%�.Qa�-
Phone N lck- 770 "
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail GIYn
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State or County License AA A A
If value of construction is 2500 or More, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONS IOIENI INE
R ATIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature ofLontractor/License Holder
STATE OF O
STATE OF F�LQMDA
COUNTY OI� G� A'r n
COUNTY OKIAAA.-) iP�.v✓
Th oing ins�ru ent was acknowledg before me
th� day of 20Lt by _
Thee��DD ing in tr ent was acknowledg before me
th —Wclay o 20 by
TUAC e(N SeRa��"
�n��n�o if�5ciw{�i�
(N�f person acknowledging )person acknowledging )
(Name of person ackno ledging)
(Signatur of Notary Public- State of Florida)
(Signatu e f Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known i OR Produced Identification
Type of Ident1
Type of Identification
Produced AURGU�����
Commission EXPIRES:oct er5120.tR
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Produced
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014