HomeMy WebLinkAboutBuilding Permit Application ALL APPLII�C��A��Bt INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:�" � 0I Permit Number: k TJ C)G-4
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Building PermitlQ11cation
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34382
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here kAC
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#:'31419-- 50Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under t -checkispermit a appy:
nHVAC F]Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
QElectric � OGenerator
Plumbing Sprinklers M Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
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Cost of Construction:$ Utilities:oSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: 4e/ .77
Address: Arr'�77 Company: I�fd g_� (e
City: State:fL Address: &Q/ .#- e
Zip Code: Fax: City: ";4- ! Stater
Phone No. - 3 e Zip Code: %3�'l S Z Fax:172--9(o.T"q9`T
E-Mail: Phone No. .7*72--41(05'1106 4o
Fill in feesimple Title Holder on next page if different E-Mail:'12,d4fsp '" fIma;
Owner f. rr�
from the wner listed above) State or Coun License: —
If value of construction is$2500 or more,a RECORDED Notice of Commencernbht is required.
SUPPLEMENTAL CONSTRUCTION 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: 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 jCounty makes no representation that is granting a permit will authorize theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 our Notice of Commencement.
T ;7 -
ature Of Owner Agent/Lessee tfthature of Contractor/License Holder
STATE OF FLORIDtS.�t STATE OF FLORIDA
COUNTY OF � e-) COUNTY OF-
The for oing Instrqment was acknowledged before me The for ing instr4ment was acknowledged before me
thisa— day of %Y-kn e 20M by this 111W ay of kJAW-#-9 20-M by
��A ei 7'axtr Kay&- \�)I-Muffl T L-"-)ur ham
(Name of person acknowledging) (Name of person acknowledging)
'48!L- 4Q&41 44w-
�Signature of Notgry Public-State of Florida (6ignature of Notaui State of Florida)
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Personally Known P*9 cation Personally Known OR Prodod 114 * '
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Type of Identification Pro. Type of Identification Produced
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Commission Na.
Commission No. o;f(Se
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Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETE
46000 SOS
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