HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: ^ 19 - � to
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
Address: q 2/in?. IP. Df -
Legal Description:
Residential C/
Property Tax ID #: _ '3r-{ U a- - (Dog — Oolsg OGc> - Qt Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
1/1tt /lar 411fe Si<m ---XAr C of/7' 14<0�cr! /nJrc✓
Mechanical
Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $ S2 -i6 �
_ Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof
Utilities: -Sewer _Septic Building Height:
Name
Address: yjy2. MtR�E �p Qc
City: Q: Pr'0 4L State: -EL
Zip Code: ayo,ga- Fax:
Phone No. 1kr1 a - 5'lq $
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 26e(Yor more, a RECORDED
Name: eurtl5 SeLmy'1on'5
Company: Lu -am Air $tj.Sfems )>uc
Address: i(eIS SI- Ni I(C]aA Sreeg lir
City: Poe -'T STLkCIe State: -L.
Zip Code: 34 95,2 Fax: T7,1 33S 146 s
Phone No. 77,1 33,5-3032
E -Mail: cu t(klr Sti s P C'0I ac n
State or County License: CA C 05 )310 S40 -1e
Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip: Phone: I Zip:
_Not Applicable
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, 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
commencine work or recordine vour Notice of Commencement. n
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Signature of Owner/ Agent/ lessee
Signature of Contractor License Holder
STATE OF ®
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STATE OF FLORIDA Sl / ✓C1e
l..
COUNTY OFORIDA .5� L
COUNTY OF
The for oing instrument was acknowledged before me
a ei
The for oing instrume t was acknowledged efore me
7 @g
this day of 26JZ by
this day of 20Jby
Clrl'�15 .SAMAno15
GyrT-LS SAM010
(Name of person acknowledging)
(Name of person acknowledging)
,
(Signat of Notary Pubh& State of Florida)
(Signat of Notary P lic- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced .�. agy� dAMEBdAFRAB
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Commission No. A(Se AIMONfFF01463041P
MY COMMISSIONiFF0145N
Commission No./1�/B Y5�3F * " (506lliVA S. 2017
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* EXPIRES: May 5,2017
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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