HomeMy WebLinkAboutBUILDING PERMIT APPLICATION----------------
r ALL APPLICABLE INFO MUST BE YOMPLEfED FOR APPLICAT►ON TO BE ACCEPTED
Date:
Permit Number:
o rt„ _
SCANNED
Building Permit Application 13Y
Planning and Development Services St. Lucie County
Building and Code Regulation Division
230o Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
Residential
PERMIT APPLICATION FOR: TO Select from dropbox, click arrow at the end of line
oonnr,rED IMPROVEMENT
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name: C
Setbacks
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Lot No.
Block No.
Back: "15 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
New sc�eex� m on-exi5-6 00i concr?{-e. S
CONSTRUCTION INFORMATION:
__. N.A111L—cneCKan apply:
_ HVAC _Gas Tank Gas Piping Shutters
Q Windows/Doors
Electric Plumbing Sprink
�� "" lers 0 Generator � Roof Roof pitch
Total Sq. Ft of Construction: ll/�Z
�1 S Ft. of First Floor:
Cost of Construction: $ 1 D��i L� Utilities:n-Sewer 0Septic Building Height:
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Name:
City: PSI.' ,. , 14 rK1C Company:S�li�ylj� P1IAM,l,r%_/YY\
P 6q_4JrL State: fC_ gddress:
Zi Code: Fax:
Phone No. Cam' S� State:_
E-Mail:
Zip Code: 3 Fax:"
Phone No. _)-) ( Z f ��
Fill in fee simple Title Holder on next page (if different E-Mail: l from the Owner listed above) Q UIY1LYlLrVYL
State or County License: C 02,Fzi (A
If value of construction is $2500 or more, a RECORDED Notice of Commencement is reouired_
Address:
City:
Zip:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
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- MORTGAGE -COMPANY: -Not-Applicable
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Name:
Not Applicable
Address,
City: State:
— ZIP: Phone:
Zip: Phone: I
OWNER/ CONTRACT
BONDING
Name: COMPANY: Not Applicable
_
Address:
City:
Zip: Phone -
OR 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.
which Is in conflict With any applicable lHothat wners granting
rwill
esauthorize
bylaws or and covenants that may restrict olrprohibit 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 accordance with the approved plans, the Florida Building Codes and St. Lucie , in all respects, perform the work
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 Your Notice of COMM
2nCPrOPnt
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA� f
COUNTY OF
The f rgoing instru t was a ledg efore me
tnis:"6 1 ia� f TR In i n Ao`Y _ _ erg
Name of perso'n mj� ng statement
Personally Known � OR Produced Identification
Type of Identification
Produced
ObW ta O(iO q iZLj / V
gnM e of Notary Public- StbVof Florida l
Notary Public State of Florida
Liza D Mayfield
Expires 07131/2 19
UPEMW
COUVIEW VIS
SREVIREW'ISOR
UNTER
W.
STATE FLORIDA�
COUNTYy OF
Thef oinginstrup Ent as ckn wled before me
this t�day of._y_�° z by
l I—V�t�l�
Name of pZY gngn making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(signature of Notary Publi ted�St� of Florida )
Commission No. I, -
PLANS
of Florida
MANGROVE
REVIEW