HomeMy WebLinkAboutBuilding Permit Application,PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION"TO BE ACCEPTED
Date: Permit Number:
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:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
aitional worK
Mechanical
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Back: Right Side: Left Side:
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pertormea unaer
_ Gas Tank
s permit - check a
_ Gas Piping
a
Shutters
Lot No.
Block No.
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Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ( Utilities: _ Sewer _ Septic Building Height:
Name /o..ee-e,c',2.roL &2-1��" Name: (_urti5-so-mrnon S
Address: 67 1/* Company: CAS_rMrn Atr SjSfemS )1UG
City: �Z% State: MY Address: (( I S 5 N r I (o C{ r.eer, D,-
Zip Code: 1.. 45' Fax: City: !PcQz ST Lucke State: rL.
Phone No. J/ -r -10"p 12e30 Zip Code: 34�-52) Fax:
E -Mail: Phone No. 771 33,5 "3d_32 -
Fill in fee simple Title Holder on next page ( if different E -Mail: CUstLjr' S� coo) "r,cr�
from the Owner listed above) State or County License: CA C 05 )R !O Sale "
if value of construction is 2b8Tor more, a RECORDED Notice of Commencement is required.
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It
MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
Not Applicable
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, 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 recor ' g your Notice of Commencement.
Signature of Owner/ Agent/'Lessee Signature of ContractorfLicense Holder
STATE OF FLORIDA�
COUNTY OF �� d.Lu`'tz-
The forgoing instrument was acknowledged before me
this le, day of 9aA-e �- 20_ by
(Name of person acknowledging)
(Signature of Notary Pub ic- St a of Florida )
Personally Known / OR Produced Identification
Type of Identification Produced
r CHRISTINE B. E%Mmmission No.
MY COMMISSION 4 EES59284
T
EXPIRES: April 4, 1017
--mow OUOJGf IiOI SEfVICRS
ZONING SUPERVISOR PLANS VEGETATION
REVIEW REVIEW . REVIEW REVIEW
Commission No." 6_
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
FRONT
COUNTER
STATE OF FLORIDA
COUNTY OF o�c�_
The forgoing instrument was acknowledged before me
this day of 46 20-' j by
(Name of person acknowledging)
(Signature of Notary Publi tate of orida )
Personally Known - OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENGLISH
alXiY COMMISSION a EE 8592#-
e
EXPIRES: April 4, 2017
Bonded Thri Budoet Notay S rvi a -
SEA TURTLE MANGROVE
REVIEW REVIEW