HomeMy WebLinkAboutBuilding Permit Application I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED,,
Date: - —M 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:
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Address:
Legal Description:
Property Tax ID#: y4IJ2), ° (6 03 • C)12-1 • Q002 I 1 Lot No.
Site Plan Name: Block No.
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Project Name: I
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Setbacks Front Back: Right Side: Left Side: "
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CONS RUCTIdN INFORMATI®N.M
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Additional work to be pertormed under this permit—check all that appy:
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_Mechanical _Gas Tank _Gas Piping _Shutters j' _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Lin . 00 Utilities: —Sewer —Septic i Building Height:
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Name r%�/on^
Address: POO LA—) )Pr' �'�l�o,y►,4 c ��. tr�Ga�rrr'°
City: T-, �r.�.-�C 4— State:_19f� Address: o0zip code: Fax: City: ?' State:F
Phone No. 7 2 ^24?,L/_o y Zip Code: TD, Fax:
E-Mail: CC L_LG GC-) IN,OL, ,COO Phone No 727 2A�ee_a �; O
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Fill in fee simple Title Holder on next page(if different E-Mail C C L';• L C, L .6e)prl
from the Owner listed above) State or County License 1C Gc: o2 q?
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Lvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sk1PPLEMENT_�.1.CONST,+ �fION 1.1 .N L./�W IN�F�;RI\/IAT1Q
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 insp ction tend to obtain financing, consult with I er o an attorney before
commencing wor or fetc-ording yor Notice of Commencement.
ature of Owner/Lessee/C actor as Agent for Owner Signature of Contra o License Holder
STATE OF STATE OF FLORIDA
COUNTY OF FLORIDA,, _ COUNTY OF ss� 1..x-0_
The forgoing instrument was acknowledged before me The forgoing instrum nt was acknowledged before me
this e day of n�w 20 g by' this�day of RQ, 20& by
I�,rte ��b�n �i�.ar�s ��-►�r�
(Name of person acknowledging) (Name of person acknowledging)
ature of Notary Public-Sta of Florida) ignature of Notary Public-Ske of Florida )
Personally Known d e i ti Personally Known OR Produced Identification
Type of Identification +R� LASHAHNA INGRAM a of Identification
•tP �e�' duced
Produced ;2°. .�: Notary Public-State of Flor df
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=•+ .• y Comm.Expires Dec 20,2 18 ,°ta �s'- LASHAHNA INGRAM
9r ° mission#FF 17724 C mission No. °2.' + °� Nota
Commission No. F F;o;;.�'� (Sc lm = * M COMM.(5efiOc-state of Florida
Bonded through National Notary A sn. 9A+ t Y Expires Dec 20,2018
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Commission#FF 177,11,
on ed throw h National Notar As n,
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