HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO P4UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: froPermit Number: �U
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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: To Select from dropbox, click arrow at the end of line
='PROPOSED IMPROVEMENT LOCATION' .--
Address: 2-(,04,D S Ll-(a
Legal Description:
Property Tax ID#: `-Vz?__A- L,?,z4_ opo-�— � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.-DE OF'WORK:
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CONrSTRU;CTION INFORM'ATI'ON x
Additionalworkto.re er ormeunder this permit-check allJ!Jappy:
HVAC Ei Gas Tank Gas Piping _Shutters Q Windows/Doors
WElectric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ Utilities:Sewer O Septic Building Height:
OWNER/LESSEE °' CONTRACTOR:
.
.
Name Name:
Address: Company: L
City: ��2Q_ State: Address: bLJI10 M
Zip Code: C Fax: City: /� S/ta�t�er r/ �
Phone No. 2. J - ��j Zip Code: 54gl. L Fax-TR-`--tt1P I -q4e,� -�
E-Mail: Phone N - 2
Fill in fee simple Title Holder on next page(if different E-Mail: C
from the Owner listed above) State or County License: (T 4�, o_-)�lQL+J
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTALCONSTRUCTION LI,E:N',LAW INFORMATION:
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:.
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
C. s
_Sign u of Owner/Lessee/Agent Signat re f Contractor/License H er
STATE OF FLORIDA ` L STATE OF ORIDA r r1^
COUNTY OF COUNTY OF
The for oing instr ent was acknowledged before me Th orgoing instr ent was acknowledg fore me
this May of 20 L� thi- day of 20 y
(Name of person acknowledgin ) (Name of person acknowledging)
(Si o !�5ry Pu c-State of Florida V (Si nature of Nar P blic-State of Florida)
�Personown OR Produced Identification Personally Known OR Produced Identification
pe of Identification Produced duced
Commission No. (Seal) Commission No. (Seal)
ANGELA M HUFF
Revised 07/15/ 0 Commission#FF 234730 :�o�"R�"`a;'; ANGELA,nm, Oq HUFF
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DATE
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INITIALS