HomeMy WebLinkAboutBuilding Permit Application d.
.PPLiCABLE INFO MUST BE COMPLETED FOR APPLICA,TION'TO BE ACCEPTEV
Date: AIJP Permit Number:_ JQ���
Building Permit Applicatidn
Planning and Development Services `
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)452 -1578 Commercial - _ Residential
PERMIT APPLICATION FOR:
Address: j 4 D ,41A
Legal Description:
Property Tax ID#: /� .��<i 0/� /3��,��d a Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�ti na wor o e pe orme un er t is permit--c ec a tat appy:
1�Mechanical _Gas Tank —Gas Piping Shutters _Windows/Doors
_,-•Electric _Plumbing - r Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name %Z�c d 'Ips n_ D,Q�i v__ 'Name: L'ur is S
Address: �5d fdc!u /1/d, Company: rsfems )kc
City: State: !�y Address: l 1p 15 S i {(C a reert-- Dr'
Zip Code: 11501 Fax: 51 City: 5tate
1.i,Cs�
: I✓L.
Phone No. Zip Geode: 44 9502 Fax:
E-Mail: - - -- — _ Phone No.. 772 33,5" -3Q1
Fill in fee simple Title Halder on next page(if different E-Mail: C.4st0.lr sti,. 'c {-r.��,
from the Owner fisted above) State or County License: -A C 0 " 18 10
If value of construction Is2SWor more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable MgRTGAGE COMPANY: ,Not Applicable
Nar'ne:_ Name. ,
Address: - Address-
city: Statte• : . City. State:
•'"•�
Zip:, Phone: Zip: Phony:
FE iMPIE TITLE HOLDER: Not Applicable ' ' BONDING ODMpAN y-. _Not Applicable
iVa'ttie•. _ Name•
Address: Address:
Zip: -_-- _----- Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thework and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no rbpresentation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with a%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 pians,the Florida Ruildkjg Codes and St.Lucie County Amendments.
The following building permit applications are exempt from uQdergoing a full concurrency review:room addlSons,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to andira,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 Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/Ucense Molder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF z I-•V cl e COUNTY OFi, 5r Lucie
The forgoing instrument was acknowledged before me The forgoing instrument was admowledged before me
this 4 day of _ �- .20/r by this day of 20. by
(ntame of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-staWof Florida) (Signature of Notary Public-State oW6rida)
Personally IQ own f OR Produced Identification Personally Known OR Produced Identification
'type of Identification Produced .aa q`m,ffi Type of ldertticatfon Produced
v YYt:ONIOH w}t�
Commission No. �SQdB�I * I) I:XPIRES:Apsd4,a017 Ctimrnission No. � -ofia * S..
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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