HomeMy WebLinkAboutBuilding Permit Application PPLICABLE INFO MUST BE COMPLETED FOR APPLlCATIOMTO BE ACCEPTED
Date: ®���
, Permit Number:
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Building Permit Application
Pianning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-7.553 Fax:(772)462-1578 Commercial _ Residential
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PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: I F 3; ny - Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L lite j�_ ,r'
WFechanical
wor to a pe orme under this permit-check a tat appy:
_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:S 7 Utilities: _Sewer _Septic Building Height:
Name /--,i Name: L'uriLS .�OI., M06.3 _
Address, 11 RC3 �i Jam,.,A �, Company: r
City: e s State: r--L- Address:_ 15 `�r I a t` n Dr -
Zip Code: -;�_ Fax: City: 51 Lu.e ice. _ State: fl.
Phone No. r1'VZip Code: 3M% Fax: 1779 335 )94&__. _
E-Mail: Phone No. 77 . �c�
Fill in fee simple Title Holder on next page(if different E-Mail: ct s'��lr �!4,•;,52-Cao 1• ,cm_ _
'from the Owner listed above) State or County License: C-1 C 05),6 10 52 '
If value of construction IsZWeor more,a RECORDED Notice of Commencement is required.
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ESIGNERIENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicableame: Name:
ddress: Address•
ity: State- -- City: Sfiate:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:. _Not Applicable BONDING COMPANY: Not Applicable
Name' Name:
Address: Address,
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with anyy 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.
It►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
commencin work or recorftg your Notice of Commencement.
Signature of owner/Agent] essee Signature of,Contractor License Holder
.STATE OF FLORIDA - STATE OF FLORIDA,
COUNTY OF � G[L'/- COUNTY OF '` i'f. --
-The forgoing instrument was acknowledged before me Theforgoing instru ent was acknowledged before me
this,e day of klJ p�-�-,w4-rte ,20r.�by this xodayof 2!� ., 20 X by
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Kblic-, to of Florida) (SignSture of Notary Publlc-Stpg of Florida)
Personally Known OR Produced Identification Personally Known ZOR produced Identification
Type of ldentiflcation Produced Type of identification Produced.
Commission No. (Seal) Commission No. •.. (Seal)
REVIEWS FRONT ZONING. ' SUPERVISOR, P6ANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
' DATE
-AECEIVED
MATE
COMPLETED
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