HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:03 J 23/201l(?Permit Number:_
~~~li~-...........,'!'i
COUNTY .
FLORIDA --
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
Legal Description:1q Ow Lfl ~rt)rY\l\PI 2105.'12>F7 JJa.fS tI at GOII+LM i eun E 230.J F-+~r POe,TI4 CoM f liS-
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Property Tax ID #:352/::t -2.3Lt -OOD'-DDD-~Lot No.-.i-.-===---
Site Plan Name:_
Project Name:_
Setbacks Front _
Block No._
Back:Right Side:Left Side:_
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CO \LW I I-=LP_~_~"'---_
o Windows/Doors
DRoof
Total Sq.Ft of Construction:_
DOCostofConstruction:$Qf(j)D -~~~-----
SCf.£!;of First Floor:
Utilities:USewer D Septic Building Height:_
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Address:0~~~~~~~~~~-----
City:ftr--t le(c~State:,EL
Zip Code:~413tO'2.Fax:112-LfuJ5 ,L.{qlf5
Phone No.'1'72.-4toS,IIoOLP
E-Mail:_CldVo.n±a..¥,~Ym\b (42 hohnall.COrK-
State or County License:OA-C-03110(04use,:tt:e'BB
..........,.'-'--'----1.....:...>=7-="""-------State:.a.
E-Mail:_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is $2500 or more,a RECORDEDNotice of Commence ent is required.
DESIGNER/ENGINEER:_Not Applicable MORTGAGE COMPANY:
Name:Name:_
Address:Address:--=:---:-_
City:State:City:-::-;-State:
Zip:Phone:Zip:Phone:_
_Not Applicable
_Not ApplicableFEESIMPLETITLEHOLDER:_Not ApplicableName:_
Address:_
City:,....--_
Zip:Phone:_
BONDING COMPANY:
Name:_
Address:_
City:._
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.LucieCounty makes no representation that is granting a permit will authorize the permit holder to build the subject structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,bylaws or and covenants that may restrict or prohibit suchstructure.Please consult Withyour 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 BuildingCodes and St.LucieCounty 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
commencin work or recordin our Notice of Commencement.
I ature of Owner!Agent!Lessee
~~~~~Fci~ORIt9alld LUtt~
Signature of Contractor/License Holder
STATE OF FLORI=<?~f I .
COUNTY Of ~/n LUCte;,.;
The forg~ing instpent !fas acknowled~efore me
this 23t..day of Q ren ,20illfJ by
Df/n1Lfe/I.».-:The forgoing instrument was acknowledged before me
th~S2!7day of rY)Q.(l!h ,201&]by
Ut1m{/e/c rA
(Name of person acknowledging)
\\11111/1/
{ignature of Nota;7b'-Statp.,.~ri!t~J *?~-'~'o::.••••••y....,.'~
~"!;-v.'~'l-I'IRES•••v~
Personally Known O~,,#~;"'~ntifiq\j~
Type of Identification producelLJ i!2 ::::,/lr i~'i5~=2.~co •~v 2~.'C:I":::~~~~~~~§::::~Commission No.------------'i-::;~.p?>(<i:I,;;JIl#':~~~d/p ~'ij <is.V)~
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Revised 07/15/2014
REVIEWS MANGROVE
REVIEW
DATE
RECEIVED
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTlE
REVIEW
DATE
COMPLETED