HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
�INFO
JMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ]!/ d=�/ I Permit Number: \—I <S
RECEV'_D AN 23 2017
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:
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Address: 3CJb LAS S-e_x I-Or,
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwor to e pertDrmed under this permit—check all tat-appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric VPlumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ U (7 0 (') Utilities: —Sewer —Septic Building Height:
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OR
Name 'G,r`' '.v �5 ; s"' '! Name.:`(.�rl`S;. :/�l�: SD•✓l..
Address: " U� :;. 5� fir' C�orri an rr5 LLQ OVA
City: State: Address
Zip Code: 3`"I `'/ 6 Fax: City: i , - Stater
Phone.NoD 71� qO I 3 3 5 Zip Code: 3`��t'l Fax:
E-Mail: Phone No(2 7 L
Fill in fee simple Title Holder on next page ( if different E-Mail-
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable 'v
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 b
commencing work or recording our b1ptice of Commencement.
I
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Signature of Owner/Agent/Lessee/Contractor Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 15 1z' COUNTY OF 2, L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a3 day of--'S"a ,I\ 20-a by this Ajday of 7:�qf , 20_�J by
(Name of person acknowledging (Name of person acknowledging)
i
(Signature of NotaryPub _State of Florida ) (Signature of Notary P blic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L —Produced—VL
'' MARIE GI
VENS
«•,.,, D NA MARIE GIVENS =,a MY COMMISSION�G23
Commission No. �� '•: MISSIONtI00022023 ommission No. EXPIRE �r�ber0
EXPIRES;December 16,2020 '•f„:s� Bonded Thru Notary Pub0e
odd Ttw Notary Publle Underwrite
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED !
ev.