HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO IVUST BE COMPLETED FOR APPLICATION.TO BE,ACCEPT.ED
Date: I� LPermit Number: -
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61
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 COf'nmef CIal- Residential
PERMIT APPLICATION FOR.
PROPOSED IMPROVEMENT LOCATIQNr
Address: .''yP.
Legal Description:. : .
Property Tax ID#:Jy3& 331 x.000? ^ 000 f Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:' Right Side: Left:Side:.
DETAILED DESCRIPl'ION 'OF WORK µ{
a.;
2C,Oksci'4S
CONSTRUCTION 1NFORM`ATION
Additionalworkto a performed under this permit—check all that appy:
HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 02 70y Utilities: _Sewer _septic Building Height:.
0111%NER%LESSEE : "
CONTRACTOR
Name: ��5 e4Q2
.
Address: /1e�. Com an
City: 10 NP,P�/ rr f, _ State:A Address: 611j---:'6 "L'4`-':
Zip Code./l'� �� Fax: City: P"elu— State:/-c
Phone No. )7,9- 9 71 4(_?7 Zip Code: 3 Yelde9 Fax: ?9d,
E-Mail: Phone No. 27,� L/G 39JO
Fill in fee simple Title Holder on next page(if different E-Mail:_52f&e-,'c cw-! 61je(/ rl�11—
frdm"the Owner listed above) State or County License: (2,4e_/,Yl
If value of construction.is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAVH INF(?RMATION Fz
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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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. LucieCounty 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
corrimencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Agent Sign u e of Contractor`/License Holder
STATE OF FLORIDA < h ��� STATE OF COUNTY OFORIDA3L
�� .
COUNTY OF
The for mg instar ent was acknowledged before me' The r ging instru ent was acknowledged b fore me
this��iay of 20 �by thi lay of, 20 acknowledged
�7 ,
N me of person acknowledging) a of person acknowledging)
(Si f No ry Rublic-State of Florida-) (Sig ota Public-State of Florida)"
Personal R
gention . Personally Known Pr duced Identification
a of Identifica o WWiEced
WtLA Commission#►FF 23 •r `�- Notary public ' M HGFCommiss •�c fres May( Commission No. • omsson� 1Florida
%'„° ��` Bondedthrough National Not ��OF F�opO,,` My Comm,Ex FF 34730
"���"• Ronde Expires May 27.2019
WWI ION[V Assn.
Revised 07/15/2014 -'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER .REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW-
DATE
COMPLETE
INITIALS