HomeMy WebLinkAboutBuilding Permit Application All APPLICABLErNFO MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f 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
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PERMIT APPLICATION FOR:
PROPOS-ED IN- ME LOCATION
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Address: �B c_('� ri v�e
Legal Description: ��'( ��� ZZ � �'� �?
Property Tax ID#: 30e 0®o& Lot No. �a
Site Plan Name: L Block No.
Project Name:
Setbacks Front Back: Right Side:_ Left Side: S�
DETAILED DESCRIPTION OF WORK z '
VaJ to d{- e iyoyl
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CO:NSTRUCTiQN INFORMATION '
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Additional wor to be performed under this permit–c ec' a tat 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:
OWNER/LESSEE `y CONTRACTOR
)V''
.,
Name Name:
Address: lUob)a-C/'e5� 17f 11/e Company:
City State:_ Address:
Zip)Code, .° '3`" '. Fax: City: �'� ^–I Stater
�`�`g- �GP�Gd
Phone No. Zip Code: Fax:
E-Mail: Phone No � 83?O
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License C.'re- /Z5.70"ge
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
L
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, bylawsor 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 recording our Notice of Commencement.
10
(JU�vua.e
Signature of Owner/;Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA S 4 L U c- I-� STATE OF FLORI
COUNTY OF COUNTY OF
The for oing instr eAt wa aacknowledged before me The forgoing instrument wap acknowledged before me
this 9+day of �Hti��Y" ` 2010 by this �day of A� 20/4 by
( me o erson acknowledging) (Name of person ac n edging)
C
(Signature of Notary Publi State of Florida (Signat u/blic-State a
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced o` ce
i$EPdEE PHII LIPPE _
,1,jtCgomPublic,nS#r tee ioridsCommission No. i is on No.7C
LI9A L W:FF
ply comm. expires f�Gar. d, 24iL� ;�' �? N1Y COMMISSIONd574�.� EXPIRES Febn� 019
REVIEWS_ FRONT ZONING SUPERVISOR PLANS 'VEGETA ,t.l l a-n 5:6EATlffdR E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
k-e—v. 7/2014