HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( ^ t}
Date: Permit Number: �51�
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 arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: `r
Address: e
Legal Description: 1,2cy 1)
Property Tax ID#: ) c,�. f j L` 0 00 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF:WORK:
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CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit–check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Jz do S . Ft. of First Floor:
Cost of Construction:$ �� a i G Utilities:cn Sewer O Septic Building Height:
OWNERAESSEE: S:CONTRACTOR:
Name_ Name: (ii/'
Address: ,Company: 2 Ca_
City: Cvr,���e- Stater Address:
Zip Code: Fax: City:���1'y{') Stater
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Phone No. � ,�,� �� �,�c,��� , Zip Code: � Fax:
E-Mail: Phone No. —,GC�/�
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: zi r2/1'
n
e of construction is$2500 or more,a RECORDED Notice of Commencement 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:
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 thepermit 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
commencing work or recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent Signature o ontractor icense old
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF �' - _, COUNTY OF s.
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 6 day of UC* 20 'Irby this IS_ day of be.: .20 W_ by
(Name of person acknowledging) qJ (Name of person acknowledging)
n ure of Notary;UMW_State of Florida) t nature of Notary Public-95te of Florida)
Personally Known OR Produced Identification Personally Ki •wr►.,•"ex OR Produde'd Icle` ification
Type of Identification Produced Type of Ident' r t' oduced}'H110110 -Stata of tlonG ;,
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Commission No. "rr �wr.�_�Y"P{," <a Commission ST����
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Notary Public-State of Florida
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Revised 07/15/2 4�'' Bonded through National Notary Assn. `
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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