HomeMy WebLinkAboutBuilding Permit Application -All APKICABLE INFO MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date. Permit Number:
.S.
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: L7/U/�'�C;r - / l+r�l
Legal Description: I U '�-fes. ,s�Z.F> Y'A C e-ob 6F
Property Tax ID#: r7Q _,goo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AdditionalKwork to De pertormect under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
_Electric _ umbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 5-cDo` Utilities: Sewer —Septic Building Height: •
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Name C iz y -t Ca ��� ��� Name:
Address: e:�,S o2_CS l-4=J�A'1A-e-- 5 7-- Company:
City: l ~%��[=�'L- � State:% - Address:
Zi t
p Code:-3 ��z ,�,,2'� Fax: City: State:
Phone No.,- -77 2 i'S' - 9 zz Zip Code: Fax:
,.
E-Mail:k'- - C, C-',- ./ r^-,c=_ ecnl9AA- Phone No.
Fill iii 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 Comencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not
Applicable
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 Count 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.concurre.ncy.review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen en 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 inspecs" . If you intend to obtain financing, consult with lender or an attorney before
commencing work oporecording your Notice of Commencement.
S�ignatur/bf Owner/Agent/Lessee Signature of Contra ctor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF E! COUNTY OF
,
The forgoing instrurAent wasNc nowledged before me The forgoing instrument was acknowledged before me
thls�dayof 20jGby this day of ------J 20 by
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(Name of personac�jnwledging) M (Name
of person acknowledging)
'"'
(Sigeature of Not Public-State of Florida) (Signature of Notary Public-State of Florida
0
Personally Known . OR Pro ") Ide 'fication Personally Known OR Produced Identification
Pe of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I
-Re_V_.7/2U14