HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: r1 �� 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: Y,,,C_q,
Address: C2,201 Iva1 O Ac
Legal Description
Property Tax ID#: , Flit Lot No.
Site Plan Name: Block No.'
Project Name:
Setbacks Front Back: Right Side: Left Side:
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�'itiona wor to epe orme un er tis permit–c ec a t at app y:
_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:$ l� ,wy Utilities: —Sewer —Septic Building Height:
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Name 4v r• Name:
Address: a� Gtfi�i` - Company:
City: d ( r6State:rG- Address:
Zip Code: 3V9W Fax: City: State:
Phone No. ��� 9 ��3� Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
_--- -
-Name:-
- wane:
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 Bolder 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 i spection. If you intend to obtain financing, consult with lender or an attorney before
commencin rk or recording ur Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 . L vc N COUNTY OF
The�grgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this —1 day of G A t'\N ,`20� by this day of ,20_by
G-'•1be. 6 acb �la
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary.Pub c-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Pr d lin n sivENs f'
Personally Known, OR Produced Identification
State,oi0�da r,
Type of Identification Y P�, p„bi;c oTy(?e of Identification
Produced �- �L :o`Pa e`�.`_MY Co m.ExDi es Dec 13, ',Produced
EE 3587
s•: a = �om.missio m V,a Assn v
Commission No. �$rJrD rr" o =($�� djhr° 9�N31a>, '�°".'_`Commission No. (Seal)
1111111\\ w$j'"�]y �
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW. REVIEW ' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.