HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: 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:
PRC3POS€D INP'1�01/EMEITI LOCATIt?Nf e �� ;��d,i
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Address: //C'J/ 4;0e1'1/ S� 7 z1 W,,2
Legal Description:
Property Tax ID#: 3Z/03 ' 5'69C,9Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
1/ Electric ✓Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor-
-.--Cost of Construction: Utilities: —Sewer —Septic Building Height:
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Name /1'd ooh• C��2.&v-r4 Name:
Address: I, ,Co.mpan,y:- Y�LIy �� ra ii Phi
City: �n )'`�/�L P State:/��; Add'relf�/U/_Le��,:G� e�"°� sh
Zip,..Code Fax. Citjr l/� %e State: G
Phone No. oS'� .t ZIp,4Qde5�� 3 Fax: 177j -3�10-75SS
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail e, y�/J�� istic'� Tlr,h-�
from the Owner listed above) State or County License_4 � /Gi/o?5�ep
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: 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, 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 'nspection. If you intend to obtain financing, consult with lender or an attorney before
commereing rk or recording our Notice of Commencement
i ure406�Aer/Lessee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF taN _. COUNTY OF
The forgoing instrument was acknowledged before me The for ling instrument was acknowledged before me
this S day of 20 Ho by this day of '(Aqa� 20� by
Vyi 1\-e r C�0CC\,4.r. ' 6\:P r
(Name of person acknowledging) (Name of persYn acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification V
Type of Identification• Type of Identification
Produced Produced
Commission No. ommission No. (Seal)
J�tiPR�w6, LASHAHNA INGRAM •`""""'� _
oSPR�p�s�•,� LASHAHNA I
=e°r „i': NOtar Public-S r
+ MY Com :Expires Dec 20,20.8 . M
_'. • _ u tic State of Floc
REVIEWS FRON 9rF) e�INComm syl €RRh81Q�. PLANS VEGETA I(3 lY�(�EExpi eOAi@ ,Rpl
COUNT ' �pdeGthr. u®h p( ip/�p�NgfaryAs n. EVIEW REVIE _ �'R'��'��R (�IF,
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DATE a�Y Assn.
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RECEIVED
DATE
COMPLETED
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