HomeMy WebLinkAboutBuilding Permit Application nri�l� • w •aw
,ispUCABLE INFQ MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date• �-� 7"<P-1� Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Dlvislon
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-3.553 Fax: (772)462-7.578 Commercial ^� Residential
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PERMIT APPLICATION FOR:
Address: qp-
legal Description.
Property Tax ID##: has 7�� o� �. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
7'na wo to a pe rme un er t is perm --c ec a that apply;
echanical _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:$ _ _ Utilities: —Sewer _Septic Building Height:
Name GG�GL�cay.�- L Name:_ Curtis SAAmo-n5. .
Address: ��
-Company: A i r
city: State: - Address: I k l S S�, 2L, r
Zip Code: Ste' - Fax: _ City: T le State°��•
Phone No.� - Zip Coder Fax: 12a
E-Mail: -------- PhoneNo.
Fill in fee simple ride holder on next page(N different E-Mail: r )
from the Owner listed above) state or County License: C41 C 0 5 f 10 - S' _
If value of construction is2SOWar more,a RECORDED Notice of Commencement is required.
71-00
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DESIGNER/ENGINR: Not Applicable 14�10!RY�GE Ct3MRANY: Not Applicable
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Name; Name
Address: Address,
City: State: City:
Zip: Phone- Zip. Phony:
FEE SIMPLE TI ME HOLDER: Not Applicable• 56NOING COMPANY: ,_Not Applicable
blame% Name:
Address' Address:
City: City; .
Zip: Phone: Zip. Phone:.
OWNER/CONTRACTOR AFFIOVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation bas commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will aut orire the ermit holder to build the subject structure �'
which is in Conflict with 8nxpplicable Home Owners Association rules,by aws or an covenants that may restrict or prohibit such
structure.Please consult wit. your Home Owners Association and review your deed r 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 pians,the Florida Buildipg 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-residents!use ,
WARNING Tia OWNER:Your failure to Record a Native of ComnMencerne"t may result in your paying tw ce for
'm em'
to your property.A Notice of Commencement must be recorded and posted on the 2obsite
before the first Inspection.if you intend to obtain financing,consult vrrith lender or an attorney before
commenciniz work or recordinx vour Notice of Commencement. !/
Signature of Owner/Agent/Lessee Signature of Contra ooret /Litense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF `� V C t COUNTY OF; i" r '
The forgoing instrument was acknowledged before me The forgo" instru nt was acknowledged before me
this�day of�__ .20LS by 'this day of L —26-by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-St of Florida} (Signature of Notary Public-State of rich}
Personally Known OR Produced identification Personalty Known OR Produced identification
Type of identification Produced_ QWR%=g,wo-a8t Type of Identification Produced W a
� s �W ` 1)EXPIRES: Commission No. 11� d - - �#Me
Commission Na. —
��,�� Bone�diNrab Nei�y � ES:AptA4,901
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Rev.