HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � ( Permit Number: Co
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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:
PROSD INPR1/EMENT lOCATI4N
Address: 5i e 'f t e e-
Legal Description:
Property Tax ID#: ,�j�J� 5 o3- ocm?-Doo - Co Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:T Right Side: -Left Side: NIA
DETAILED DE5CjRIPT'IQN t)F
CONSTRUCTt0N INFORMATION p.
Additional work to be pertormed under this permit-cneCK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
OWNERjI.ESS E C NTRACTOR
Name r
Address: _ Company:
City: �pY� i��� Stater Address:
Zip Code: 3qqR _'L Fax: City: State:
Phone No. J - 9 Zip Code: Fax:
E-Mail: 0- CPI Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or C my License
If value of construction is 2500 or more,a RECORDED Notice of Comm 176ment is required.
SUPPLEMENTAL CNSTRUCTIQN:LIEN LAW 1N'FORMATtQN• j
r
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 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 ins ction. If you i to obtain financing, consult with lender or an attorney before
commencing w or record i ur No ice of Commencement.
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=TATEOF
wner Lessee/C tractor as Agent for caner Signature of Contractor/License Holder
ORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary 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)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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