HomeMy WebLinkAboutBuilding Permit Application a
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n j
Date: Permit Number:, pt'-1"
Building Permit ApplicatioREC IVE®
Planning and Development Services �- 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 _Rft4f'`i ING
Phone: (772)462-1553 Fax: (772)462-1578 Commercial ResidefftWcle County- F1
PERMIT APPLICATION FOR:
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P# OPOSDIN '�f}UEMEG�T LOCgTION � � rc
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Address: o SOi-A Se G J 2
Legal Description:
Property Tax ID#: l 1 ° �('0° -sq � ®�'' Lot No.
Site Plan Name: Block No.'
Project Name:
Setbacks Front Back: Right Side: Left Side: i
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CONjSTRUCTIO
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Additional work to be performed under this permit-check all tat appy:
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Mechanical —Gas Tank _Gas Piping —Shutters "� _Windows/Doors
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Electric _Plumbing —Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2z� o °o O Utilities: —Sewer —Septic Building Height:
01NNER/LESSEn
T2A W-1111.1111 � k �<
COL �
Name O S- GS Name:
Address: /C,& (✓,� "(�� �1r2 Company:
City:
�n c StateG Address:
Zip Code: b Fax: City: State:
Phone No. S/ �'I 9 -7 YtLqc1 C1 Zip Code: �' Fax:
E-Mail: CaCq 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
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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.l 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 rqcording your Notice of Commencement.
Signature of 0 w--ner/ —
I X-s7ee/G6ntra as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s I COUNTY OF
The foLrgoing inst ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_&by this day of ,20_ by
6ameerson acknowled ing) (Name of person acknowledging)
(Sig ature of Notary Public-StMA of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification v Personally Known OR Produced Identification
Type of Identification Type of Identification
oduced Produced
Commission Na � LAA � olMiorida Commission No. (Seal)
NOtaoYnmExpires public Dec 20,2018
Commission
� t oval aS tNotary Assn.
REVIEWS Bo dzom*d.�� SOR PLANS VEGETATION SEA TURTLE MANGROVE
/ EW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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