HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JJ SCANNE® Permit Number:
BY RECEIVED
• St. Lucie County MqR 1 1 1U1B
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Building Permit ApplicationPerm;tt;n9atment
Planning and Development Services St.
Lucie CooePunty
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:
Address:
Legal Description:
Prope rty Tax I D #: 172/ 'SDI - 0006 " e" Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Block No.
CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit-checka apply:
HVAC E] Gas Tank Gas Piping _Shutters Windows/Doors �
Electric Plumbing Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
d
Cost of Construction: $ I�� (� 0 Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name721,7Ww /_ 1 ./15120y Aye
Name:
Address:-//WAl%/fl%`P �i1/q�� _023
Company:1r, �i/7`S — �/�c7
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City:A&/a J'V"'Z/ ,Z.SLi irtf{ State: �
Zip Code: iy92%9 Fax:
-Phone No:r/'/o 110
Address: �/�70 J3eLvc�sc�
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City:(%C-.''!; d?? �s9G�
Zip Code:Fax:
PhoneNo.,6l/1_1__*9
State: �G
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:.f/yG�/Lft�/r,/L/(�ifZSGt%//f/o�DLd��O
State or County License: 12/9C /oi
/
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
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 vour NoticaaP Clnmencement.
`� F�ORIDgy
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Signature of Owner/ Lessee/C n ra or as Age or Owner
Si natty tractor/License Holder
STATE OF FLORID g
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STATE OF FLORID /n� II x o -1 z
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COUNTY OF { % (/UQL�
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COUNTY OF L� l M U[i� a. a 4
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The for oing instru ent was acknowledged before me
The forgoing instru was acknowledged efore mt cmi o
thisday by o $ m
this day of 20�J by
of
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II �t1sL�bi(i'��ir1YUV/ N m 2 03+-
Name of person making statement AIrso
—r — Name of p akmg statement
�OR
Personally Known OR Produced Identification
Personally Known Produced Identification
Type of Identificati
a of Identification
Produced " ". LORl aALAZS
P duced 2OZ/0VI, Sail. eCbl
€y • \ �': Notary Public - State of Flori
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My Comm. Exoires Noy 5, 20
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( 'nature of NotaryPublic- State of Florida)
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(Ignature o u Ic- a e of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
— - - - - ----COUNTER—
REVIEW
REVIEW--
-REVIEW
—REVIEW--
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17