HomeMy WebLinkAboutBuilding Permit Application f•
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: • •� Permit Number: (� Q`l• 0Q
RECEI
,• -�. tiT
ED
Building Permit Application JULPlanning and Development Services U13 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (77i)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR:
PROPOSED IUPROVE,MENTLQCATION
Address: t O A-gf
Legal Description: A Lo
Property Ta�-ID#: �{a l --70 3K ODD-S'— M) �2 Lot No.
Site Plan Name: Block No.
Project Nam i:
Setbacks Front Back: Right Side: Left Side:
02
QETAILED DESCRIRTION�OF WORK. } ' ..
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CQ%TRUCTION [NFORIVIAl'l(3N �
Additional orktobepertormed under this permit—check a that appy:
_MechaInical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:a �V^� Sq. Ft.of First Floor:
Cost of Cons ruction:$ oci Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE _ CONTRACTOR ,
Name Name: JR OJ erg C_
Address:�£ is. zs �x ad3 Company: ver, e CA C 0
City: State: Address: c t r��� e
Zip Code: 3 Fax: City: State:E�__
Phone No.# �7 a 3 Zip Code: Fax:
E-Mail: 47 Phone No oC Ig
Fill in fee sIImple Title Holder on next page (if different E-Mail D A W& ck ` Aen m
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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SUPPLEIVIENTALCONSTFtUCTION LIEN%LAWINF�RMATION ,¢
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: ! Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: I Phone: Zip: Phone:
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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 thepermit 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 stru 1 tures,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
commencink work or recording our Notice of Commencement.
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Signature ofJOwner/ essee/Contractor as Agent for Owner Signature of Contracto /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF p COUNTY OF N�
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The forgoing instru nt was acknowledged be f The for oing inst u ent was acknowledg d beforeit
= a
this day of 20/& by d LL, this day of 20� by
"cLia mrn� jo
x��a der i CK
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(Name of person acknowledging) ,;;� (Name of person acknowledging)
(Signature of 01tary Public-State o Florida t` ...• h' (Signature of N ry Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEW FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED,
DATE
COMPLETED
ev.
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