HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
RECEIVED
Budding Permit Application
Planning and Development Services NOV ®3 2016
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:
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Address: Lvsak o -t�Kye.-. 1'b fe1�'-�i [ C► ����5�
Legal Description: 6rO(Aye^ eywt S &6% f 6w �OLLIA� a
Property Tax I#: o ,� 03 — 0 01.ot o.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalworkto.b!e pe orme un der t is permit—check a t,at appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator v-' Roof
Total Sq. Ft of Construction: ?-4060 Sq. Ft.of First Floor:
Cost of Construction; Utilities: —Sewer _Septic Building Height: I
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Name sst* Name L
Address: t"�Vp� Company: w_'
City: VzC*4;:_ %e� State: Address:
Zip Code: 3���� Fax: City: State_
Phone No. L%6%--q9i;N. Zip Code:34Ctb Fax:7Z'3
E-Mail: I Phone No
Fill in fee simple Title Holder on next page(if different E-Mail �C'C S•�V1 ® _C&A- n
from the Owner listed above) State o =-..� C_Cl1�S7-�� (�
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: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _ of 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 inspection. If you intend to obtain financing, ,conult with lender or an attorney before
comme in work or recordingour Notice of Commencement'
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Signa r f wner/L see/Agent Signature of Contractor/License Hold
STATE OF FLORIDA . r STATE OF FLORIDA +�
Er
COUNTY OF _ ' `
COUNTY OF
The forgoing instrument w s acknowledged befoe The fo going instr ment as acknowledged be 0-rpe;
this day of I 20 I�bye a thi day of 20/ b a ��
I ��O o a m
2 m�S�i7 ? C,
(Name person acknowledging) =T (Name of erson acknowledging) �T=
(Signature o otary Public- ate of Fl rida) (Signature of ary Public-State of Florida)
Personally Knownl OR Produced Identification Personally Known OR Produced Identification.
Type of Identification! Type of Identification
Produced Produced
Commission No. I (Seal) Commission No. (Seal)
REVIEWS FRIONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2014
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