HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1/�� f�
Date: �3l `( Permit Number: �p"�,`�Op�q `-O in
SCANNED
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Building Permit Application
Planning and Development Services `��• Building and Code Regulation Division pe95,0pt
2300 Virginia Avenue, Fort Pierce FL 34982 Pecc���• �c�e Co
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
Address: gfil SCa V;voe 61-owe W1 ' Fl. RcdLcf F/, 3qR
Property Tax ID #:,? � w — l IICi 1— � r! �S A Lot No.
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Site Plan Name: Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
—Mechanical —Gas Tank —Gas Piping _Shutters _Windows/Doors
—Electric —Plumbing —Sprinklers _Generator _Roof Pitch,
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
II�11 0
Cost of Construction: $ ry fj �, Utilities: Sewer Septic Building Height:
— —
OR, N E RN 111 MS rE
JGONTRACTOR:
Name SaVl
Name:
Address:_ 106 %( %N2("r\e `{i�•
Company:
City: 1t �'eac.' State:
Zip Code: Fax:
Address:
City:. State:_
Phone No. 77L 2-No `6'f) 5r
Zip Code: Fax:
Phone No
E-Mail: u,2C4) O e A0).(aYh.
Fill in fee simple Title Holder on next page (if different
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E-MailIt
State or County License
from the Owner listed above)
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.
5 PPLE TAL GON-SR CoTI-QN =N W IN
0 A 10
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:=NotApplicable
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
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Sign ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
ST TE OF FLORIDA
7UNTY
STATE OF FLORIDA
C OF 9 i . o
COUNTY OF
The for oing instrpjn ent,,was acknowledged before me
The forgoing instrument was ac owledged before me
this, day of V, 4 20jg by
i k kSka t)a-Q Q Q 4.Lngn8 )
this _ day of 20_ by
Name o erson making statement.
Name of person maki statement.
`\
Personally Known OR Produced Identification
Personally Know OR Produced Identification
Type of Identification
Type of Identif ation '
Produced
Produced
gn ture of Notary Public- tate of Florida)
(Signature of Notary Public- State of Florida )
Commission No. Np,t�6@@M"ttA4MtNfi
By ...
Commission No. (Seal)
MY 00}AMISSIO Abe Q 2 2 11
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Notary Pu
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SOUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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