HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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 �j L
PROPOSED IMPROVEMENT LOCATION =
Address: /J t?i- -
Legal Description: ( 7► J_61a &nd ��•
a %3rnon 6RA36-2!f 9 7q- PW9
Li Property Tax ID#: V 5 da ^ S k 5 Li G- G0d "'s Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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fLED DESCRIPTION OF�IVQRK
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Additional work to be ertormed under this permit-c ec Wf, appy:
HVAC Gas Tank ❑Gas Piping _Shutters U Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$. 00d�— Utilities: _Sewer ESeptic Building Height:
OWNER/LE$SEf• CONTRACTOR -
Name ' Name. Y CLQ -�-
Addres : Company. `tt1� I LQS�f e
City: � Stater Addr�r� u f,
Zip Code: 49-67�7 Fax: City: - lne(l1rC�r �S1tla�terG� c�
Phone No. !72" 98' 134ol Zip Code:.:90A C)2- Fax: 7"`rW5-4-1q J
E-Mail: Phone No.7 Z- 05__- (0
Fill in fee simple Title Holder on next page(if different E-Mail: �1S +_
from the Owner listed above) S to or ou ty License: fh 0.�
If value of construction is$2500 or more,a RECORDED Notice of Commencemeilt 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 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,l 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.
1 ature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA 1 /��� STATE OF FLORIQA
COUNTY OF L fGt C COUNTY OF Qcl�t(" L-LlCf
The f&ing instrument was cknowled gd before me The forggoging instr Pent wa acknowledged before me
ftday of 1J0VeA"r' 20=by this i day of OV 20 _ by
619irtle,i T ui-hQdC
(Name of person acknowledging) (Name of person acknowledging)
� \Illflllll/ ��
b���i \Ililflllf
(Signature of Notary F br ( ignature of Nota ub' -Stat�O ri
�.,���0.2�, me�> �
Personally Known t� '� i Produc cation Personally Known �dd/�� Ol
Type of Identification d I o baa' � _
yp Q_ Type of Identification Produc�u,._ •
Commission No. i �'�� cx;:� �) Commission No.
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Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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