HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Dater 2 1;1�ba SCANNED Permit Number:
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=' St. Lucie County
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RR031019
- Buildin Permit Application
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Planning and Development5ervices
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Building and Code Regulation Division
2300 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
PROPOSED IMPROVEMENT. LOCATION: _ '`
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Address
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Legal Description: ')(0M t t n
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Property Tax ID#: )_ )I- LDDIQIO- DLO -l�
Lot No.
Site Plan Name:
Block No.
1
Project Name: ) if
Setbacks Front Back: Right Side: Left Side:
DETAILED -DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:-
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itiona wor to e e orme un ert isperms —c ec a appy:
0HVAC GasTank ❑Gas Piping ❑Windows/Doors
_Shutters
01 Electric U Plu rin ers Generator oof
L� Roof pitch •`
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Total Sq. Ft of construction: 1166 Sq. Ft. of First Floor:
0 OSeptic Building Height:
Cost of Construction: $ Utilities: Sewer
OWNER LESSEE: CONTRACTOR:, .
Name Name:
Address: Compan
City: 2i `t? State• 1 Address:
Zcity-
Zip Code: Fax:
' �g� �3 Zip Code:CO Fax:
state -EL
Phone No. !� �1
Phone No._I r a —
E-Mail:
E-Mail:
Fill in fee simple Title Holder on next page (if different I
from the Owner listed above) State or County License:
if value of construction Is $250D or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: • �,
, .. _ . _ ..
DESIGNER/ENGINEER: - N
of Applicable
MORTGAGE COMPANY: _Nott Applicable
Name:
Name:
Address:
Address:
City: State:
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 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
nature bf Contractor/License Holder
STATE OF FLORIDA
COUNTY OF rL 1 A 0
STATE OF FLORI
COUNTY OF L l�
The n Inst nt we acknowleci before me
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Name of person making statement
Personally Known L__� OR Produced Identification
Name of person king statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
10
ignature of Notary Public- State ri) ry,:.,n.M 4r=
P. _ .•..,�. Nr.
C o• s.1'
00 Notary Public Stat@ of Fb . t ..1t
f Amanda P Sanderson 4r
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Notary Public- State f I'
''11 Nota. Public State of Flo'
-CGlrlio Alo. GL (y �da P Sanderson
�JiMy Commission GG 2112
Expires 0412512022
ar
PLANS
VEGETATION
SEATURTLE
MANGROVE
W R E pires 04125/2022
SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17