HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDr Gf3� 7Date: � 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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATION:
Address: C
\
Legal Description:
Property Tax ID#: w - mo Lot No.
Site Plan Nam Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_DETAILED DESCRIPTION OF WORK:
IDO\ `(v C\2c� \v.�v� N
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CONSTRUCTION INFORMATION.
itiona work to be performedd under t is permit-check all appy:
El HVAC Gas Tank ❑Gas PipingMGenerator
Shutters windows/Doors
❑Electric ❑ Plumbing Sprinklers Roof
Total Sq. Ft of Construction: '\) S . Ft.of First Floor:
Cost of Construction:$ ��(�ocUtilities:In Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:.
Name Name: C
Address: do, Xn
Company: C
City: - State:t Address: 1617 5l_ lJ&60
Zip Cod ax: City: L)l ,�, � yec State:��
Phone Noj 0 - ���C � Zip Code: 3AA6K9- Fax:
E-Mail: \ Phone No. 3L- )-J/9 P 1999
Fill in fee simple Title Holder ext page(if different E-Mail:
from the Owner listed above) State or County License:__CCC. /570-01-? 65
JL=
nstruction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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SCT igr�ature:ocaner_Cess_ee/Agents nature of Contractor/License Holder
STATE OF FLORIDA,$- f aa STATE OF FLORIDA
COUNTY OF COUNTY OF m,
The fp�joing instru ent w s acknowledge before me The f rgoing instru7t was acknowledge before me
this-t-6�day of l 20 acknowledged
this�� day of „��21 20 by
(Name per on acknowledging) "(Name of er o 1 a nowledging)
(Signature of Notary Pub i -State of Florida) (Signature of Notary Public- ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati rl,f4a aced Typ 01 @@ ' tion Produced
LLftY
MY COMMI #EE225005 CO 'f� �����/ t��e al)
Commission No. :�a• �Y1=P-O MMiS��.L
p:� EXPIRES October 04,2016 '•qwa, 10
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(407)39&01 b3 Floridallo (��)39 ESP►RE N#EE2?$
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Revised 07/15/2014 m t)1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS