HomeMy WebLinkAboutBuilding Permit Application.pPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Z Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
Residential
V/ -
commercial
Address:
Legal Description:
Lot No.
Property Tax ID #: yZ� � b� 3� �� -
Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
/ me 112r Llll-e-
tAUUIIIVI IUS .•v... - __ , -- _
Shutters Windows/Doors
-'Mechanical _ Gas Tank _ Gas Piping _ —
Electric — Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name
Address:
City: ► >> ('`bvC-S=4 "4"�n'_ State: LIS
Zip Code: v2soq `-1 _ _ Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ! urtl5 Sa W on s
Company: CCAs rdm A<< S�Sfe
Address: l(e l5 S E i
City: Vo Q_ - LkcState: FL.
Zip Code:Fax: '1U 335 i �6
Phone No. �3�32
E -Mail: C 01
State or County License: Cfl C 2 5► i/ D- S34cA
If value of construction is Z59dor more, a RECORDED Notice of Commencement is required.
i
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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordiVg vourrecord' Notice of Commencement.
Signature of Owner/ Agent/ lessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY 21 Luc,Q
STATE OF FLORIDA
OF Co"nky
COUNTY OF St L�Cke C.o uf-v�y
The forgoing instrument was acknowledged before me
_Decem
The forgoing instrument was acknowledged before me
this I day of oec 20 l to by
—
this l dayof � 20 1 b
� y
G
5
n U� S �4V-,-\
(Name of person acknowledging)
A/",
(Name of person acknowledging)
(Signature of Notary Publ' State of Florida)
(Signature of Notary Public ate of Florida )
Personally Known ✓ OR Produced Identification
Personally Known OR Producg Identification
Type of Identification Produced Y
Type of Identification Produced DEBML-
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Commission No. r i QQ`7571F, • .'YWWISSl0N'F
EXPIRES: September
S PAT WIMISSION r 11 22755
2� emission No.l'r.��75 /J *, *WIRES: September5,2019
N,
' OF Balled nru Budget Note
19 +JE,� nee , ,a nru &4w NAry sen;
Senim
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.