HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� l
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SCANNED
St. Luce County
_ ----- _ _ Building Permit Appli
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Planning and Development Services
Building and Code Regulation Division ® 3 AT 3�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
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PERMITTYPE: Ali _ ,�- N\uVUJcTK ;rNs-q ab(
Address:
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Property Tax ID #:
Site Plan Name:
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Project Name:_
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Lot No.
Block No.
Additional.woiktobeperformed underthispermit— cheIckalltthat;apply:
Mechanical Gas Tank Gas Piping- ,+ Shutters _ Windows/Doors
9'--_Electri61 Plumbing—Sprinklersj*'%,---;;—Generator _Roof Pitch
Total Sq. Ft of Construction: 5Y_, SquFt,lof First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name CSVi.2R 0.Kv&- fc
Name: JU�,i��\ '�Ql A
Address: qki Qw
Company: U �U� AOC
City: `�' (km State: _
Zip Code: -ItAgkk�? Fax:
Phone No.
Address: APO
City: Iy'J Q State:_
Zip Code: q�-25Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail \p Chie Faaex a R o) . C& 1
State or County License �L' f°) l�r�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
a LEMENTALGONSTRUCTION LIEN LAW INFORMATION:
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 reviewyour 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
"WARN!TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
CE FOSTEDOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE AND
WITH YOUR ENDER OR 9N THE JOB IMY ASV EY 6 FORTHE T IN G . OU NOTICE OF COMMENCjFAOU INTEND TO OBTAEMENT."
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The forgoing inst(u.,ment was acknowledg d efore me
this day of. 20by
f r oing instrument was acknowledged befo rp ; l:Ydb,
day of 20.by{I.°C
Name of person making statement.
a of person making statement.
Personally Known OR Produced Identification
ersonally Known OR Produced Identification
Type of I i i ation
`�
Type of I n ' 'c ion
Produced
Produced
(Signature o046fary Public -'State of FV6rida )
(Signature of Not Public- State of Florid
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. L///ly