HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c
Date: G �a S Permit Number: (D
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Building Permit Application
Planning and Development Services
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 LOC TION:
Address:
Legal Des iption: p
1 + /
Property Tax ID#: 1 c"� �l�a t' �t��� ( /� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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4oq-tf),
CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit-check a InShutters
appy:
HVAC Ga Tank ❑Gas Piping a Windows/Doors
Electric L=1 Plumbing Sprinklers Generator g Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ (),5-0100 Utilities: 0 Sewer 0 Septic Building Height:
OWNER/LESSEE: e CONTRACTOR: '
Name Name:
Addre s: �Li Company:
City: 11 State: Address:
Zip Code: Fax: City: State:41
8
Phone No. ZipCode: -Z.- Fax: -1
E-Mail: Phone No. 179-4U,4-L5'9<
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Fill in fee simple Title Holder on next page(if different ��JStat
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from the Owner listed above) or County License: C�1' ��70
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU. ION LIEN LAW INFORMATION:'
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: -IGame:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Coun�r 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 your is f Commencement.
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_Signatu a of Owner/Lessee/Age Signatur of Contractor/License.1,61der
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STATE OF FLOR A STATE OF FLORIDA
COUNTY OFLAA&A. COUNTY OF ,
The f r, oing instr4peF&was acknowledged before me The forgoing instrument was acknowledged before me
this day of JUANk 20LS-by this day of Ivft a 20 1,5_by
(Nam-ofpdrson acknowledging) (Name erson acknowledging)
gnature of Nota Jw1c.State of Flori a ' ature of Notary P t -State of Florida
sopa v—il Kn— OR Prod_ ce ntificat'on ersonall OR Produced Identification
Type of Identification ProducedN ype of Identification Produced
7 . ;.: MY COMMISSION ii E Bri2a�
Commission No. 't�. p� EXPIRES:May ,QOt�mison No. 7 ,;� ilreal) LIBERTY AKING
Bonded Thiu Notary Publ UndenulAers !; = MY COMMISSION H EE 87,
EXPIRES:May 4,2(O i
••,pf,q;.•` ru oary u a nde• • rs Y
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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DATE
COMPLETE
INITIALS