HomeMy WebLinkAboutBuilding Permit Application I'
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a�
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 i Residential
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PERMIT APPLICATION FOR:
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Address: I rtJ S' I,IJG LA .3 (�
Legal Description: dC�1-
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Property Tax I D#: �J2�, 01 �rOL- � �� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to a per orme un er t is permit–c ec a t at app y:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Genera ltor _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: Utilities: —Sewer Septic Building Height:
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OUI ENERLESS ��a,� � y ONTRA OR: �
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Name �� r/ f / / 9cc A:� Name: f/)°, dcCL,A-
Address: 9/�� �1 c��rv� Company: A �l`��e1Xe�
City: �Z'' S'7 ley i! State: Address: / Y -St'J U/a Tt7ii1 e�
Zip Code: 3 Mb(*D Fax: City: L State:_is
Phone No. Zip Code: Fax:
E-Mail: Phone No Q
Fill in fee simple Title Holder on next page(if different E-Mail O~a4lle 69 o Glom
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from the Owner listed above) State o'County License (_'/4r;
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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Sl1PPIIR FJ ALC®NSTRikJGTIDN LIEN LAW UN'FfJRl1/IATIQ.N;
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 an'yapplicable'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.
Signature o ner ssee/Contractor as Agent for Owner Signature of C or/License Holder
STATE OF FLORIDA / STATE OF FLORIDA J/
COUNTY OF s�I lUtl^� COUNTY OF s;4
The for oing instrWn was f cknowledged before me The forgoing instr a as a nowledged efore me
this day of _ �7�b�—� 20 by this day of =l/ 20 by
(Name of person ckn wledging) (Name of person ac ledging)
(Signature of Notary Pu ' -State of Florida) (Signature of Notary Pub -State of Florida)
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Personally Known R,h��8JNed Identi8�tiq N i Ptgrsonally Known R,f�1' d IdentifIgAWiSNILLO
Type of Identification S=° o`p't Notary Public-State of Flori a Pe of Identification :'2°. �`� Notary Public- to e o ori a
5'o Commission#FF 184850 "oduced =' ; Commission#FF 184850
Produced c; ,�T P,, Comm.Expires Dec 22,20 B
—�— a• My Comm.Expires Dec 22,20 8 ` 9. „`O`° Bo ed t ou h National Not As n.
Commission No. /—f " hroughNationalNotaryAs n mmission No. � d� , g
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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