HomeMy WebLinkAboutBuilding Permit Application ti All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: Permit Number:
L41 40- 41-1
IIl Building Permit A tieation
Planning'and Development Services �p
BuNing and Code Regulation d!v!slon
2300 Virginia Avenue,Fart Pierce FL 34982 /
Phone:(772)462-2553 Fax:(772(462-1578 Commercial Residential_,,
PERMIT APPLICATION FOR: � y,}
Address: 7Wk
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Lepl Description: -�& [`x,Y"ns
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Property Tax ID#• U G ._-f' �- C3 01 — 00� �
_ � 1 � / t+ --� Lot No.
Site Plan Name: Block No.
Project Name':..
Setbacks Front Back:_ CD _Right Side: 0 Left Side: CD
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Additional work tone pertarmea un er this peffnit—clieCK all that app . 4::-e-r) c_e.
_,,,_Mechanical _ Gas Tank _Gas Piping _Shutters Windows/Doors
.�Electric Plumbing:.____ _Sprinklers Generator _ Roof
Total Sq.Ft of Construction:,�� ,.� � Sq.Ft.of first Floor.
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Cost of Construction:S - Utilities: - Sewer Septic Building Height:
Name 1.(1 V Name:
Address:
Ll',
�# ` man
P y, �i
City: St e: Address: oJ ,.
Zip Cede: c�2 Fax: City: %xk, State.__L
Phone No. 1U' -, Zip Code* 7 Fax:
E-Mail: -Q. P q Yi'1-CLJ i Phone No C� —
fill in fee simple T e Holder on next Irage(if We E-mail QrnT
from the Owner listed above) State or County cense
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 TIRE 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 Coun�r makes no repregentation 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 1 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 inspqction. If you intend to obtain financing,consult with lender or an attorney before
commencin6wGrk_iir recording our.Notice of Commencement.
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Signatur f Owner/les /Contractor as Agent for 0 r Slgnat of Contractor/License Holder
STATE OF FLORIDA 5T OF FLORIDA Lac P
COUNTY OF L .li� COUNTY OF
The forming Instru nt was cknowledged before me The forgoing instru ent was cknowled d before me
this day of 20�j by this daffy of 2o:j by
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(Name of person acknowledging) (Name of person acknowledging
( ' Public-State of Florida) (Signature Pu ltc-State of Flan a)
Personally Known ` OR Produced Identification a °rally �„
Type of t ion a ''r. ANGELA M HUFF
PfaduCed Notary Public-Stat of Florida
Produced ••_ ommission #FF 234730 '
o ��"a,,; ANGELAp COmmisSi I�t9.,oFn�oP• M p �>'f1�019
• RSP � s �.• y Comm.Expires M
Cornmissiori erR a �� ublic-State of Florida Oullueu ouyh National Not Assn.
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Commission#FF 23
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xpires May 7,2019
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