HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
p SCANNED Permit Number:
Date: Z? BY
u,•� ucie County
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Vlrginfo Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click here
�:.PROP,O'SED�a�RRC111.'EM�NT�1�'CATI.ON::' •�..:.: � � ..... . �� : ;. �.. � ...
Property Tax ID #:��: ` Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ona wor o j� orme un er this perma it- c ec apply:
VAC L J Gas Tank Gas Piping _Shutters 11Windows/Doors
Electric Q Plumbing []SprinklerssIn Generator EIRoof
Total Sq. Ft of Construction:hI ` 5 Ft. of First Floor:
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Cost of Construction: $ ��1�,-�'"in • l0 Utilities: 11 Sewer OSeptic Building Height:
CONTt#iCTOR:
Name C
Name• �• �C
Address: G1 Ll ��Q1
Company: a
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1 City:Doc -LU6 State.
Add ess•M�e_�s&
Code• Fax:
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State-
Phone No q _5_ C9anFax:-4-4-1-
Zip Code
e•,
Fax:-4-4-1-
E-Mail:
Phone No.
Fill In fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:C
If value of construction Is 52500 or more, a RECORDED Notice of Commencement is requires.
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DESIGNER/ENGINEER
Name:
Address:
City:
Zip: Pho
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
e:
FEE SIMPLE TITLEHOLDER:
Name:
Address:
City: I
Zip: Pho
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
e:
Zip: Phone:
OWNER/ CONTRACTO
I certify that no work or in
St, Lucie County makes no
which is in conflict with an,
structure, Please consult w
In consideration of the grai
1n accordance with the apF
The following building perr
accessory structures, swim
WARNING TO OWNEF
improvements to your
before
#e first inspec,
r
Signature of Owner/ Age
STATE OF FLORIQAI
COUNTY OF `�-
The forgoing Instryrnent
this jay of
T,.%- . `TL- % 1
(Name of person acknov
R AFFiDVIT: Application is hereby made to obtain a permit to do the work and installation as indlcated.
to Ilation has commenced prior to the issuance of a permit.
epresentation that is granting aj� ermit will authorize the permit holder to build the subject structure
8pplicabie Home OwnersAssocration rules, bylaws or and covenants that may restrict or prohibit such
th your Horne Owners Association and review your deed for any restrictions which may apply.
Ming of this requested permit, I do hereby agree that I will, in all respects, perform the work
roved plans, the Florida Building Codes and St. Lucle County Amendments,
iit applications are exempt from undergoing a full concurrency review: room additions,
ping pools, fences, walls, signs, screen rooms and accessory uses to another non-residentiat use
: Your failure to Record a Notice of Commencement may result in your paying twice for
property. A Notice of Commencement must be recorded and posted on the jobsite
ion. If you intend to obtain financing, consult with lender or an attorney before
Lessee Signa re-6 6r—ontractor/License Holder
G COUNTY OF S-LV-kt-
owled a before me���` k''•,, The f Ing instr ment was acknowledged before me r
• _s
20 by a *��_ this ayof� 20�7by
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of Notary Publi):- State of Florida )
Personally Known ✓FOR Produced Identification
Type of Identification Produced
Commission No.CX"—I 0 W >5 (Seal)
Revised 07/15/2014
me of person acknowledging)
SSignature of Notary Public- State of Florida ) I F
Personally Known +�� OR Produced identification
Type of identification Produced
Commission No. er)-0(Seal)
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SUPERVISOR
PLANS
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SEA TURTLE
MANGROVE
COUNT
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REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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