HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDI
Date: Permit Number:
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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 here
PROPOSED
Address:
Legal Description:
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front. Back: Right Side: Left Side:
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DETAILED DESCRaPTION
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0 De Performed �c�deir tnis permit—c"ecl all apply:
Additional work t MLLLI�MWAIW
HVAC E]Gas Tank E]Gas Piping IShutters E]Windows/Doors
11 Electric Q Plumbing OSprinklers CGenerator ❑Roof
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost of Construction: Utilities:'n_Sewer Septic Building Height:
W VLE $_tLL
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CONTRACTOR '`
Name PQ Name. JICY
Address- a, lahe—, Company:
City:
'LI &il —State: rL. Address: &09/ '�S. QrK,Ef 2/Cu
Zip Code:s5yq62 Fax: City: r4 State: Yl;(—
Phone No.(IP) RET Zip Cocle:&/W Fax:
E-Mail: Phone No. 6___ 166;K0
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Fill in fee simple Title Holder an next page if different E-Mail:
from the Owner listed above)
SOteorCoty License: 6
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If value ofconstructionis$2500 or more,a RECORDED Notice of Commengdment 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 County 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 Horne 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 t 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.
S�'Iiilature of owner/Agent/Lessee Signature of Contractor/License Holder ,
STATE OF FLORI A �Uefe) STATE OF FLORI ` /
COUNTY OF� __ fid COUNTY OF�„ e ni L_;C)
The forgoing'rnst ent was acknowledged before me The forgoing instrcXnent was acknowledged before me
thisidayof &ES+ _ 20'/`by this'?— dayof /'tcs ,26Wby
6'alwele.1
(Name of person acknowledging) (Name of person acknowledging)
t 1#####lilt
(Signature of Notary Off F ( lgnature of Nota ub' Stat�a ri<cla,l.
,ON" md�` QO.�tiyPIHES !••fib s
Personally Known t Pratlu i t#iication Personally Known Oi���is''** 01Antific�fi��G�
Type of Identificatiad ! o^ b�:Q= Type of Identification Producr�ur. sg E,=
..d� �+ �S y �o • eM tb:w=
Commission No. '% �;` �) Commission No.
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED