HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO'. rl'�ETED FOR APPLICATION TO BE ACCEPTru `
Date: Permit Number:
Building Permit
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
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HOOD FEB 0 7'20)9
sT. Lucie cou , Permitt;,'
Residential f_l
PERMIT APPLICATION FOR: P- l7 O J P1, i OUANNE®
RV
Address:
Legal De:
Property Tax ID#: e/ iUd—(LU
Site Plan Name:
Project Name:
Setbacks Front Back:
_Mechanical
Right Side: Left Side:
_ Gas Piping
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction Sq. Ft. of First Floor:
0
Cost of Construction: $ i [DO Utilities: —Sewer _Septic Building Height:
Lot No.
Block No.
_ Gas Tank
Shutters
Windows/Doors
OWNE /LESSEE
GONTRA MOR'
Name
Name. �9
Address S
Company:.A
City: G Stag
Address:
City: State:_
Zip Code: , 7 Fax:
/
Phone No. J 9
Zip Code: Fax:
Phone No
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E-Mail: iS�
Fill in fee simple Title Holder on next page( if different
E-Mail
State or County License
from the Owner listed above) �JI.7/30
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
1
SUPPLEMENTAL CONST U LIEN LAW INFORMATION:
DESIGN R/ENG INEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name
Name:
Address: _ ✓ .
Address:
City: Sate:
City: State:
Zip: Phone %
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 grahttng a permit will authorize ,the, ermit holder to build the subject _structure
which isinconflict 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 rpermit, 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'Amendnferlts:
The following building permit applications are exempt from undergoing a fullconcurrency review: room additions,'
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another nor' -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 our Notice of Commencement.
Sig nvature pW- wn Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder. ,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 4,>{
COUNTY OF
The forgoing instru nt'Gas acknowledge efore me
thisday of �'by
The forgoing instrument was acknowledged before me
this _day of 20_ by
V
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced Ft, 4) L
Produced +'
f.
0
(Signature
(Signature of Notary Public -State of Florida )
"""• KAREN S. NIEL EN
Commission
fi State of Florida•Noi�ryy p�ublic
- on N GO'iiflb84
Commission No. (Seal) ' -
`? d'r My Commission Expires
'
y :
•9,Sn °` June 12 2022
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