HomeMy WebLinkAboutBUILDING PERMIT .PPLICABLEy INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t� Permit Number:
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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:
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Address: �+���7 e2L'Llzt� .
Legal Description:
Property Tax ID#: d f. ��['�— 1��7 � (1% 1C� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit—check all that appy:
Mechanical _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: $ Utilities: _Sewer _Septic Building Height:
Name 1z- Name: Curt(S .5cLiiir'lorl5
Address: ��tr� ('7 z'2 Company: C(,S-r,h1 A (c SCJ S to&)S AJ c
City: Pr 10— ; '2� ZL/C'�f% State: Address: t( IS S �_ Ni I( , a.. Q f- en Dr
Zip Code: �'f/r�S Fax: City: Pop-7 S T L4 �� r State: F-L.
Phone No. 04`1/w- %�/� Zip Code: 34qS;L Fax: ' 7U 335 1 `26
E-Mail: Phone No. 772 53,S - 3L 2
Fill in fee simple Title Holder on next page ( if different E-Mail: CU�Ick ic -,�J -, V Cmc ) Cm
from the Owner listed above) State or County License: Cfl(�05 )'S'/0 Sale
if value of construction is25e(lor more,a RECORDED Notice of Commencement is required.
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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, 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.
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Signature of Owner/Agent/lessee Signature of Contractor License Holder
STATE OF FLORIDA �j� STATE OF FLORIDA
COUNTY OF
J LGA�' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrume t was acknowledged before me
this day of 117i cu✓ ,20 by this- day of d✓ 26 by
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of NotaryP Stat f Florida ) (Signature of Notary Publi State of rida )
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Personally Known I, OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _F.� Pu,/ rj4prsT►NE B.EN Si Type of Identification Produced
Q�{ lay COMMISSION#EE 859 „ p �aY,°�eCHRISTINE B.ENGLISH
Commission No. C f/ ���d/ * I) EXPIRES:April 4,201 Commission No. � /� ` `�p4WMISWN#EE 859284
�,4TF OF F��o Ba+ded Thru Budget Notary S .5 * * EXPIRES:April 4,2017
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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